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Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments
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Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (25 October 2024) | Viewed by 6648

Special Issue Editor

Dr. Anna Clementi

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Guest Editor
Nephrology and Dialysis Unit, Santa Marta and Santa Venera Hospital, 95024 Acireale, Italy
Interests: acute kidney injury; chronic kidney disease; cardio-renal syndromes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acute kidney injury (AKI) is a major complication in hospitalized and intensive care unit patients and is independently associated with short- and long-term mortality. Furthermore, AKI is associated with high morbidity and mortality and a greater risk of adverse outcomes after hospital discharge. After AKI, the incidences of chronic kidney disease and end-stage renal disease are increased. AKI is not a single disease but a series of heterogeneous syndromes, and if these lesions are left untreated, the patient's condition can worsen, resulting in complete loss of kidney function or death.

As there are many causes of acute kidney injury, more in-depth studies are still needed. For this Special Issue, we are calling on researchers and clinicians to submit valuable research on AKI to generate more knowledge and awareness of this issue, as has been done in nephrology, internal medicine, critical care, and other disciplines and skill areas.

Dr. Anna Clementi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

  • acute kidney injury
  • acute renal failure
  • chronic kidney diseases
  • nephritis
  • critical care
  • renal replacement therapy
  • inflammation
  • risk factors
  • therapy
  • diagnosis
  • outcomes
  • predictors

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Published Papers (6 papers)

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Research

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13 pages, 789 KiB  
Article
Prevalence and Risk Factors for Acute Kidney Injury in COVID-19-Hospitalized Patients in Poland Across Three Pandemic Periods
by Paweł Edyko, Marta Zdunek, Maja Nowicka and Ilona Kurnatowska
J. Clin. Med. 2025, 14(4), 1384; https://doi.org/10.3390/jcm14041384 - 19 Feb 2025
Viewed by 602
Abstract
Background/Objectives: Acute kidney injury (AKI) is a serious and prevalent complication of COVID-19. This study examines the prevalence, risk factors, and outcomes of AKI in hospitalized COVID-19 patients. Methods: We analyzed the data of 1223 adult COVID-19 hospitalized patients from a [...] Read more.
Background/Objectives: Acute kidney injury (AKI) is a serious and prevalent complication of COVID-19. This study examines the prevalence, risk factors, and outcomes of AKI in hospitalized COVID-19 patients. Methods: We analyzed the data of 1223 adult COVID-19 hospitalized patients from a single district hospital during three pandemic periods: 3 November 2020–31 December 2020, 17 March 2021–8 May 2021, and 4 November 2021–21 February 2022. The analysis included demographic data, comorbidities, laboratory results, chest radiographs (CT lung scans), and outcomes. Results: We found an overall AKI incidence of 29.02%. AKI patients versus non-AKI ones were significantly older (median age 76.0 vs. 71.0, p < 0.001) and had more comorbidities, especially previous renal diseases, heart failure, coronary artery disease, and hypertension; they also significantly more often used diuretics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme inhibitors (ACE-Is). AKI patients more frequently presented with abnormal CT lung scans and had higher white blood cell counts, lower lymphocytes percentages, higher C-reactive protein (CRP) levels, and lower platelet counts. They more often required oxygen therapy, more days of hospitalization, and had higher mortality rates. Conclusions: Older age, comorbidities, the use of diuretics, and renin-angiotensin system inhibitors (RASI) are key risk factors for AKI, which is consequently linked to a more severe disease course and poorer prognosis. Full article
(This article belongs to the Special Issue Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments)
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8 pages, 444 KiB  
Article
Evaluating Short-Term Outcomes of Tunneled and Non-Tunneled Central Venous Catheters in Hemodialysis
by Niccolò Morisi, Martina Montani, Edwidge Ntouba Ehode, Grazia Maria Virzì, Salvatore Perrone, Vittoria Malaguti, Marco Ferrarini and Gabriele Donati
J. Clin. Med. 2024, 13(13), 3664; https://doi.org/10.3390/jcm13133664 - 23 Jun 2024
Cited by 4 | Viewed by 2065
Abstract
Background: The necessity of using central venous catheters (CVCs) in hemodialysis, coupled with their associated complications, remains a critical concern in nephrology. This study aims to compare the short-term prognosis of tunneled (T-CVC) and non-tunneled (NT-CVC) CVCs in acute hemodialysis patients, specifically [...] Read more.
Background: The necessity of using central venous catheters (CVCs) in hemodialysis, coupled with their associated complications, remains a critical concern in nephrology. This study aims to compare the short-term prognosis of tunneled (T-CVC) and non-tunneled (NT-CVC) CVCs in acute hemodialysis patients, specifically focusing on infection rates, malpositioning, and lumen thrombosis within the first three weeks post-insertion. Methods: A retrospective analysis was conducted on 176 CVCs placed between January and December 2023 at the Policlinico di Modena and the Ospedale Civile di Baggiovara. Patient demographics, CHA2DS2-VASc scores, and comorbid conditions were recorded at the time of catheter placement. Outcomes assessed included catheter-related infections, malpositioning, and lumen thrombosis. Statistical analyses, including Chi-square tests, Fisher’s exact tests, and Kaplan–Meier survival analysis, were performed to evaluate differences between T-CVCs and NT-CVCs. Results: The sample comprised 43% females with a mean age of 69.3 years (SD 13.9) and a mean CHADS-VASC score of 3.72 (SD 1.4). Hypertension (90%) was the most prevalent comorbidity. Of the 176 CVCs, 127 were T-CVCs and 49 were NT-CVCs. Infection rates were 3.15% for T-CVCs and 8.16% for NT-CVCs (p = 0.07). Malpositioning occurred in 0.79% of T-CVCs and 4.08% of NT-CVCs (p = 0.47). There was one case of lumen thrombosis in the NT-CVC group. Kaplan–Meier analysis indicated a significant divergence in infection-related catheter survival favoring T-CVCs after ten days (p = 0.034). Conclusions: While non-tunneled CVCs do not significantly alter short-term prognosis compared to tunneled CVCs, the latter show a better infection-related survival rate beyond ten days. Therefore, primary insertion of T-CVCs may be preferable when resources and clinical conditions permit, although NT-CVCs remain a viable option when immediate T-CVC insertion is challenging. Full article
(This article belongs to the Special Issue Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments)
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13 pages, 994 KiB  
Article
Obesity and Acute Kidney Injury in Patients with ST-Elevation Myocardial Infarction
by Vojko Kanic, David Suran and Gregor Kompara
J. Clin. Med. 2023, 12(23), 7311; https://doi.org/10.3390/jcm12237311 - 25 Nov 2023
Cited by 1 | Viewed by 1081
Abstract
Background: Data on the association between obesity and acute kidney injury (AKI) in patients with ST-elevation myocardial infarction (STEMI) are sparse and inconclusive. We aimed to evaluate the association between obesity and AKI and the outcome in these patients. Methods: A retrospective observational [...] Read more.
Background: Data on the association between obesity and acute kidney injury (AKI) in patients with ST-elevation myocardial infarction (STEMI) are sparse and inconclusive. We aimed to evaluate the association between obesity and AKI and the outcome in these patients. Methods: A retrospective observational study of 3979 STEMI patients undergoing percutaneous coronary intervention (PCI) was performed at a single center. Patients with and without AKI were compared. Patients were also divided into three categories according to BMI, and these were compared. All-cause mortality was determined at 30 days and over a median period of 7.0 years. Results: The incidence of AKI was similar in all BMI categories. There was no association between BMI categories and AKI (p = 0.089). The Spearman correlation coefficient between BMI categories and AKI showed no correlation (r = −0.005; p = 0.75). More AKI patients died within 30 days and in the long term [137 (18.5%) and 283 (38.1%) patients in the AKI group died compared to 118 (3.6%) and 767 (23.1%) in the non-AKI group; p < 0.0001]. AKI was harmful in all BMI categories (p < 0.0001) and was associated with more than a 2.5-fold and a 1.5-fold multivariable-adjusted 30-day and long-term mortality risk, respectively (aOR 2.59; 95% CI 1.84–3.64; p < 0.0001, aHR 1.54; 95% CI 1.32–1.80; p < 0.0001). BMI categories were not associated with 30-day mortality (p = 0.26) but were associated with long-term mortality (p < 0.0001). Overweight and obese patients had an approximately 25% lower long-term multivariable-adjusted risk of death than normal-weight patients. In patients with AKI, BMI was only associated with long-term risk (p = 0.022). Obesity had an additional beneficial effect in these patients, and only patients with obesity, but not overweight patients, had a lower multivariable adjusted long-term mortality risk than normal-weight patients (aHR 062; 95% CI 0.446–0.88 p = 0.007). Conclusions: In patients who experienced AKI, obesity had an additional positive modifying effect. Our data suggest that the incidence of AKI in STEMI patients is not BMI-dependent. Full article
(This article belongs to the Special Issue Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments)
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Review

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9 pages, 250 KiB  
Review
Neutrophil Gelatinase-Associated Lipocalin: Biological Aspects and Potential Diagnostic Use in Acute Kidney Injury
by Grazia Maria Virzì, Niccolò Morisi, Catarina Oliveira Paulo, Anna Clementi, Claudio Ronco and Monica Zanella
J. Clin. Med. 2025, 14(5), 1570; https://doi.org/10.3390/jcm14051570 - 26 Feb 2025
Viewed by 602
Abstract
Acute kidney injury (AKI) is a syndrome characterized by a rise in creatinine or a decrease in urinary flow, according to the Kidney Disease Improving Global Outcomes (KDIGO) definition. It is diagnosed in 15% of inpatients and 50% of patients in the intensive [...] Read more.
Acute kidney injury (AKI) is a syndrome characterized by a rise in creatinine or a decrease in urinary flow, according to the Kidney Disease Improving Global Outcomes (KDIGO) definition. It is diagnosed in 15% of inpatients and 50% of patients in the intensive care unit (ICU), and it is related to increased mortality. As part of a global effort aimed at the elimination of preventable deaths from AKI, there is a growing interest in identifying biomarkers that can be point-of-care and that are not influenced by the variability in patient characteristics in a relevant way. Neutrophil gelatinase-associated lipocalin (NGAL), particularly in its 25 kDa form, which is exclusively released by renal tubules, has emerged as a promising biomarker with potential use in the diagnosis of AKI in the critically ill, including its use in guiding the initiation and/or weaning of renal replacement therapy (RRT). The objective of this review is to summarize the current understanding of NGAL in acute settings, emphasizing biological and genomic insights. Full article
(This article belongs to the Special Issue Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments)

Other

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6 pages, 805 KiB  
Brief Report
The XpressCard Point-of-Care Test for Human Neutrophil Gelatinase-Associated Lipocalin Enhances the Prediction of Acute Kidney Injury
by Kendra B. Bufkin and Jeane Silva
J. Clin. Med. 2024, 13(24), 7564; https://doi.org/10.3390/jcm13247564 - 12 Dec 2024
Viewed by 696
Abstract
Background/Objectives: Acute kidney injury (AKI), a common complication in hospitalized patients, is a clinical syndrome with a sudden and reversible decline in kidney function. Within hospitalization, the average incidence rate is 2% to 5%, and 67% of patients admitted to the Intensive Care [...] Read more.
Background/Objectives: Acute kidney injury (AKI), a common complication in hospitalized patients, is a clinical syndrome with a sudden and reversible decline in kidney function. Within hospitalization, the average incidence rate is 2% to 5%, and 67% of patients admitted to the Intensive Care Unit (ICU) acquire acute kidney injury. There is a pressing need to identify biomarkers that provide early detection to enhance the diagnosis of acute kidney injury. Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as the most promising biomarker for predicting acute kidney injury due to upregulation as early as 2 h before kidney injury. Methods: Urine samples from 52 adult subjects were utilized to evaluate the accuracy of acute kidney injury diagnosis using the XpressCard for human NGAL. Sensitivity and specificity were calculated to analyze the validity of the NGAL XpressCard’s ability to accurately distinguish between acute and non-acute kidney injury. Results: The positive and negative predictive values were calculated to determine the prevalence of NGAL and predict the likelihood of diagnosing AKI. Data show that the NGAL XpressCard has a sensitivity and specificity of 59.3% and 95.8% and a positive and negative predictive value of 92.9% and 71.9%, respectively. Conclusions: The human NGAL XpressCard is effective at predicting AKI in hospitalized patients and correlates with high levels of HbA1c, which is associated with diabetes mellitus. It delivers immediate test results, which can enhance patient care. Full article
(This article belongs to the Special Issue Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments)
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7 pages, 1054 KiB  
Case Report
Acute Myeloid Leukemia as a Trigger for Hemolytic–Uremic Syndrome
by Jonas El Bachouti, Anna Domínguez-Guasch, Yolanda Arce, Guadalupe Oñate, Helena Marco, Montserrat Diaz, Lluís Guirado, Roser Torra and Xoana Barros
J. Clin. Med. 2024, 13(21), 6468; https://doi.org/10.3390/jcm13216468 - 28 Oct 2024
Viewed by 957
Abstract
Acute myeloid leukemia (AML) has not been identified as a cause of secondary hemolytic–uremic syndrome (HUS). This case report describes a woman who developed severe HUS at the time of AML diagnosis and responded favorably to initial treatment with eculizumab, which stabilized her [...] Read more.
Acute myeloid leukemia (AML) has not been identified as a cause of secondary hemolytic–uremic syndrome (HUS). This case report describes a woman who developed severe HUS at the time of AML diagnosis and responded favorably to initial treatment with eculizumab, which stabilized her condition and allowed for treatment of the AML. After one year, with stable renal function and genetic studies reported as normal, eculizumab was successfully discontinued. The prompt use of eculizumab was critical to the patient’s survival and improvement in renal function, highlighting the efficacy of early eculizumab treatment in secondary HUS. Full article
(This article belongs to the Special Issue Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments)
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