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Acute Kidney Injury: Latest Advances and Prospects

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

Deadline for manuscript submissions: 26 June 2026 | Viewed by 4845

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Special Issue Editors

Dr. Emanuele de Simone

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Guest Editor

University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, and Department of Clinical and Biological Sciences of the University of Turin, 10154 Turin, Italy
Interests: AKI; kidney replacement therapies; diabetic nephropathy; APS nephropathy; green nephrology

Dr. Kianoush Kashani

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Guest Editor

1. Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
Interests: AKI; AKI biomarkers; acid-base and electrolytes; kidney replacement therapies; extracorporeal blood purification strategies; ECMO; fluid management; simulation medicine; point-of-care ultrasonography; artificial intelligence and digital health

Special Issue Information

Dear Colleagues,

Acute kidney injury (AKI) is a complex issue with far-reaching implications, associated with substantial morbidity and mortality rates. AKI places a significant burden on healthcare systems, requiring intensive care and specialized interventions. By delving into the complexities of AKI, healthcare professionals and researchers can improve patient care and reduce the burden of this condition.

This Special Issue aims to explore different aspects of AKI, from various presentation clinical settings to diagnosis and renal replacement therapies, with an eye to future developments and “green solutions”.

This Special Issue seeks to stimulate discussion among researchers and clinicians on AKI management, comparing various clinical experiences and comprehensive literature reviews.

Every scientific contribution to this Special Issue will enrich the ongoing dialogue on AKI. We invite all interested parties to participate and share their unique viewpoints. AKI is a complex condition that transcends nephrology and impacts the daily work of many healthcare providers. A truly comprehensive understanding of AKI can only be achieved through a multidisciplinary approach.

Dr. Emanuele de Simone
Dr. Kianoush Kashani
Guest Editors

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Keywords

acute kidney injury (AKI)
sepsis
septic shock
renal replacement therapy
intensive care
specialized interventions
biomarkers
risk factors
“Green Practice”
nephrology
epidemiology
multidisciplinary approach

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Published Papers (4 papers)

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Research

13 pages, 1095 KB

Open AccessArticle

The Prognostic Value of Inflammatory Markers in Paediatric Acute Kidney Injury

by Flavia Chisavu, Lazar Chisavu, Mihai Gafencu, Diana Hanu, Ruxandra Maria Steflea, Teofana Otilia Bizerea-Moga and Ramona Stroescu

J. Clin. Med. 2026, 15(3), 1099; https://doi.org/10.3390/jcm15031099 - 30 Jan 2026

Abstract

Background/Objectives: Acute kidney injury (AKI) is common in children. Several inflammatory markers proved their utility in predicting AKI, especially in adults, but their utility in children’s populations is still under debate. Methods: We performed an observational retrospective cohort study on children admitted to the “Louis Turcanu” Emergency County Hospital for Children from Timisoara, Romania. We evaluated the utility of procalcitonin, C reactive protein, lactate dehydrogenase, ferritin, interleukin 6, albumins and erythrocyte sedimentation rate in predicting AKI and mortality in children. Results: The final cohort consisted of 131 children. The incidence of AKI was 39.6%, with more than half (61.1%) admitted in the intensive care unit. Out of twelve deaths, 11 were encountered in the AKI group. Patients from the AKI group presented higher levels of several inflammatory markers: lactate dehydrogenase, C reactive protein, procalcitonin, LDH, CRP, PCT and ferritin and lower albumins. Only ferritin, C reactive protein and procalcitonin could predict AKI development. Procalcitonin seems to increase mortality, but in the adjusted regression model, only AKI increased mortality. AKI increased mortality by 4.11 times (95%CI = 1.07–15.66, p = 0.038). Conclusions: Procalcitonin, C reactive protein, and ferritin proved to be predictors of AKI, yet none of the inflammatory markers influenced mortality. AKI is still an important independent mortality factor regardless of the underlying disease spectrum. Full article

(This article belongs to the Special Issue Acute Kidney Injury: Latest Advances and Prospects)

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15 pages, 1297 KB

Open AccessArticle

Acute Kidney Injury in Hospitalized Cancer Patients: Single-Centre Real-Life Analysis of Incidence and Clinical Impact

by Pasquale Esposito, Francesca Cappadona, Annarita Bottini, Elisa Russo, Giacomo Garibotto, Vincenzo Cantaluppi and Francesca Viazzi

J. Clin. Med. 2026, 15(2), 690; https://doi.org/10.3390/jcm15020690 - 15 Jan 2026

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Abstract

Background: Acute kidney injury (AKI) is a frequent and clinically relevant complication in cancer patients, with highly variable incidence. AKI increases morbidity and mortality, prolongs hospitalization, and may limit access to oncologic therapies. This study evaluated the incidence, risk factors, and outcomes of AKI in hospitalized cancer patients. Methods: We retrospectively analyzed patients admitted between 1 January 2016 and 31 December 2019. Individuals with cancer were identified and categorized into three groups: hematologic malignancies, solid cancers with metastases, and solid cancers without metastases. Demographic, clinical, and laboratory data were collected, and AKI was defined and staged according to KDIGO criteria, evaluating serum creatinine changes. Results: Among 56,390 hospitalized patients, 6723 (11.9%) had a cancer diagnosis. AKI incidence was significantly higher in cancer versus non-cancer patients (30.1% vs. 19.6%). Hematologic cancers showed the highest incidence (39.3%). Among hematologic patients, ICU admission, sepsis, and diabetes were strongly associated with AKI. In non-metastatic solid cancers, more conventional factors—including female sex, older age, sepsis, and ICU admission—were significant predictors. In contrast, in metastatic solid cancers, traditional AKI risk factors did not correlate with increased AKI occurrence. In cancer patients overall, AKI per se did not increase mortality risk; however, stage 3 AKI was associated with significantly higher mortality (HR 1.37, 95% CI 1.13–1.66, p < 0.001). Conclusions: AKI is common in hospitalized cancer patients, with specific patterns and heterogeneous risk factors and impact on outcomes. Implementation of tailored preventive strategies and early recognition are necessary to mitigate progression and improve clinical trajectories. Full article

(This article belongs to the Special Issue Acute Kidney Injury: Latest Advances and Prospects)

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14 pages, 3744 KB

Open AccessArticle

The Association Between Central Venous Pressure and Acute Kidney Injury Development in Patients with Septic Shock

by Nasrin Nikravangolsefid, Jacob Ninan, Supawadee Suppadungsuk, Waryaam Singh and Kianoush B. Kashani

J. Clin. Med. 2025, 14(9), 3027; https://doi.org/10.3390/jcm14093027 - 27 Apr 2025

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Abstract

Background: Sepsis-associated acute kidney injury (AKI) is linked to increased mortality and prolonged hospital stays. The exact relationship between central venous pressure (CVP) and AKI remains unclear. We explored the correlation between CVP and AKI in septic shock patients. Methods: This retrospective study included adult patients with septic shock admitted to Mayo Clinic Rochester between 2006 and 2018. CVP levels were measured at 6, 12, 24, and 48 h after the diagnosis of sepsis, and patients were stratified into two groups based on CVP levels (CVP < 8 or ≥8 mmHg). Results: Of 5600 patients with septic shock, 3128 patients without AKI on admission are included. One-thousand-and-ninety-eight patients (35.1%) developed AKI within a median of 4.4 days. The median CVP levels and frequency of elevated CVP at 6, 12, 24, and 48 h are significantly higher in the AKI group. Elevated CVP (≥8 mmHg) at 6, 12, 24, and 48 h is associated with AKI incidence, even after adjusting for mean arterial pressure (MAP) levels. This association, after multivariable adjustments, only remains significant at 12 h with an odds ratio (OR) of 1.60 (95% CI, 1.26–2.05), p < 0.001 and 48 h with an OR of 1.60 (95% CI, 1.29–1.99), p < 0.001. Conclusions: Our findings indicate that CVP ≥ 8 mmHg is strongly associated with an increased risk of AKI, even after adjusting for MAP at the 12 and 48 h time points. These findings underscore a critical 12 or 48h window for interventions to lower CVP. Full article

(This article belongs to the Special Issue Acute Kidney Injury: Latest Advances and Prospects)

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18 pages, 3009 KB

Open AccessFeature PaperArticle

Influence of Baseline Kidney Function on Patient and Kidney Outcomes in Patients with COVID-19: A Multi-National Observational Study

by Harin Rhee, Etienne Macedo, Gary Cutter, Eric Judd, Sreejith Parameswaran, Elizabeth Maccariello, Wen-Jiun Liu, Nicholas M. Selby, Josée Bouchard, Guillermo Garcia-Garcia, Javier A. Neyra, Yadla Manjusha, Josephine Abraham, Kent Doi, Guillermo Villamizar, Abdias Hurtado and Ravindra L. Mehta

J. Clin. Med. 2025, 14(4), 1212; https://doi.org/10.3390/jcm14041212 - 12 Feb 2025

Cited by 1 | Viewed by 1445

Abstract

Background/Objectives: Acute kidney injury (AKI) is a common complication of coronavirus disease-19 (COVID-19), but the impact of baseline kidney function and care processes on outcomes is not well understood. We hypothesized that baseline kidney health status may influence courses and outcomes of AKI. Methods: This is a multinational, multicenter, retrospective cohort study. We included hospitalized adult COVID-19 patients with kidney disease (AKI, end-stage kidney disease (ESKD), chronic kidney disease (CKD), or kidney transplant (KT) recipients) from 1 January 2020 to 31 March 2022, across 52 centers in 23 countries. Patients with no prior kidney function information were classified as acute kidney disease (AKD) if estimated glomerular filtration rate (eGFR) at admission was <60 mL/min/1.73 m² and as no known kidney disease (NKD) if eGFR was ≥60 mL/min/1.73 m². We defined combined outcome as death or non-kidney recovery at hospital discharge. Multivariable binary regression models were applied. Results: Among 4158 patients, 882 had ESKD, and 3038 developed AKI. AKI patients were categorized as NKD (31.8%), AKD (38.6%), CKD (23.3%), and KT recipients (3.3%). NKD patients had higher AKI severity and more intensive care unit care needs. In the multivariable analyses, the risk of the combined outcome was higher in AKD (OR 1.459 [1.061, 2.005]) or CKD (OR 1.705 [1.206, 2.410]) patients, although the risk of in-hospital mortality was similar to NKD. Among the survivors at hospital discharge, the risk of partial or non-recovery was higher in CKD (OR 5.445 [3.864, 7.672]) or KT recipients (OR 4.208 [2.383, 7.429]) compared to NKD. These findings were consistent across income categories. Conclusions: Among AKI patients with COVID-19, nearly two-thirds had underlying kidney dysfunction, with 55% identified as having baseline AKD, which had higher risk of death or non-kidney recovery at discharge compared to NKD. Full article

(This article belongs to the Special Issue Acute Kidney Injury: Latest Advances and Prospects)

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