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Acute Kidney Injury: Current Challenges and Future Directions in Diagnosis and Treatment

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

Deadline for manuscript submissions: 20 October 2026 | Viewed by 1075

Editor

Dr. Grazia Maria Virzì

E-Mail Website
Guest Editor
Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
Interests: dialysis; uremia; cardiorenal syndrome; organ crosstalk; kidney; biomarkers; chronic kidney disease; inflammation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acute Kidney Injury (AKI) remains a critical global health burden, affecting over 13 million people annually and significantly increasing hospital morbidity and mortality. Despite its prevalence, clinical management is currently hindered by a “diagnostic blind spot”: traditional markers like serum creatinine and urine output often reflect functional changes only after significant cellular damage has already occurred. As the global population ages and the prevalence of comorbidities such as diabetes and sepsis rises, the urgency of developing more proactive, precise, and personalized strategies for AKI has never been greater.

Research in this field is exceptionally timely as we move toward an era of precision nephrology. The emergence of novel biomarkers, the integration of artificial intelligence for real-time risk prediction, and new insights into the AKI-to-CKD transition are reshaping our understanding of renal recovery. This Special Issue aims to bridge the gap between bench research and clinical practice, providing a platform for the dissemination of breakthroughs that could redefine how we detect, treat, and prevent permanent kidney damage.

Purpose and Scope

This Special Issue aims to present and disseminate the most recent advances related to the early diagnosis, pathophysiology, and management of Acute Kidney Injury. We will consider contributions addressing both experimental and clinical research, with a particular focus on innovative technologies and therapies that address current unmet needs in renal care.

Topics of Interest

We invite authors to submit both reviews and articles. Topics of interest for publication include, but are not limited to, the following:

  • Novel Diagnostic Biomarkers: Implementation of NGAL, KIM-1, and cell-cycle arrest markers (TIMP-2/IGFBP7) in clinical workflows.
  • AI and Machine Learning: Predictive modeling and electronic alerts for real-time AKI risk stratification.
  • The AKI-to-CKD Transition: Pathophysiological mechanisms of maladaptive repair and long-term follow-up protocols.
  • Pharmacological Interventions: Emerging disease-modifying therapies, including mitochondrial protection and anti-inflammatory agents.
  • Renal Replacement Therapy (RRT): Precision timing and personalized dosing in continuous and intermittent RRT.
  • Sepsis-Associated AKI: Insights into inter-organ crosstalk and immune-mediated renal injury.
  • Subclinical AKI: Management strategies for patients with structural damage in the absence of functional loss.
  • Pediatric and Neonatal AKI: Epidemiology and unique management challenges in younger populations.

Dr. Grazia Maria Virzì
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 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute kidney injury (AKI)
  • biomarkers
  • precision nephrology
  • AKI-to-CKD transition, renal replacement therapy (RRT)
  • subclinical AKI
  • sepsis-associated AKI
  • renal recovery

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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18 pages, 2725 KB  
Article
Association of Serial Intra-Abdominal Pressure Measurements with Renal Outcomes and Mortality in Critically Ill Adults
by Ayşe Sarı Öztürk, Kamil Konur and Ekrem Kara
J. Clin. Med. 2026, 15(14), 5742; https://doi.org/10.3390/jcm15145742 - 22 Jul 2026
Abstract
Background/Objectives: Intra-abdominal hypertension (IAH) is a common but under-recognized condition in critically ill patients and is associated with adverse outcomes, particularly acute kidney injury (AKI) and mortality. However, the prognostic value of intra-abdominal pressure (IAP) remains incompletely defined. This study aimed to [...] Read more.
Background/Objectives: Intra-abdominal hypertension (IAH) is a common but under-recognized condition in critically ill patients and is associated with adverse outcomes, particularly acute kidney injury (AKI) and mortality. However, the prognostic value of intra-abdominal pressure (IAP) remains incompletely defined. This study aimed to evaluate the association between IAP levels and clinical outcomes, and to determine its prognostic significance in intensive care unit (ICU) patients. Methods: This prospective cohort study included adult patients admitted to the ICU between 2024 and 2025. Serial IAP measurements were performed using the transvesical method on days 0, 1, 3, 5, and 7. Demographic, clinical, and laboratory data, along with severity scores (SOFA and APACHE II), were recorded. Patients were followed for 90 days. Primary outcomes were AKI and 90-day mortality. Statistical analyses included regression models, survival analysis, and ROC curve analysis. Results: The prevalence of IAH was 54%. IAH was significantly associated with advanced age, male sex, higher body mass index, increased comorbidity burden, sepsis, positive fluid balance, and higher disease severity scores. Patients with IAH had a significantly higher frequency of AKI occurrence and increased mortality. IAP levels positively correlated with serum urea and creatinine levels. Serial IAP measurements, particularly on days 5 and 7, showed progressively improved predictive performance for mortality. Survival analysis revealed significantly reduced survival in patients with IAH. Conclusions: IAH is highly prevalent in critically ill patients and is strongly associated with renal dysfunction and mortality. Serial IAP measurements may provide useful prognostic information in critically ill patients; however, these findings require validation in larger studies. Full article
(This article belongs to the Special Issue Acute Kidney Injury: Current Challenges and Future Directions in Diagnosis and Treatment)
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13 pages, 809 KB  
Article
Mid-Term Exposure to Air Pollution and Acute Kidney Injury Incidence: A 10-Year Study in Eastern Poland
by Adam Gryko, Anna Kurasz, Jolanta Małyszko, Sławomir Dobrzycki and Łukasz Kuźma
J. Clin. Med. 2026, 15(13), 4929; https://doi.org/10.3390/jcm15134929 - 25 Jun 2026
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Abstract
Background/Objectives: Air pollution is associated with many adverse health consequences, including deteriorated kidney function. The aim of the research was to determine the association of medium-term exposure to air pollutants and hospitalizations due to acute kidney injury (AKI). Methods: The retrospective population-based [...] Read more.
Background/Objectives: Air pollution is associated with many adverse health consequences, including deteriorated kidney function. The aim of the research was to determine the association of medium-term exposure to air pollutants and hospitalizations due to acute kidney injury (AKI). Methods: The retrospective population-based study was conducted on the EP-PARTICLES cohort between 2011 and 2020 (80,000,000 person-years). We estimated municipality-specific associations between air pollution and AKI admissions using generalized additive models with Poisson regression. Results are reported as risk ratio in AKI admissions (RR) with corresponding 95% confidence intervals (95% CI). Results: During the 10-year study period, 47,467 AKI cases were reported (median age 77 years, IQR 68–84; 51.2% women). Mean concentrations of pollutants were 21.4 µg/m3 (SD 5.2) for particulate matter with a diameter of 2.5 μm or less (PM2.5), 7.5 µg/m3 (1.8) for nitrogen dioxide (NO2), and 1.8 ng/m3 (0.8) for benzo[a]pyrene (BaP). In mid-term exposure analyses (lag 0–30), each 10 µg/m3 increase in PM2.5, PM10, NO2 and CO, and each 1 µg/m3 increase in BaP, was associated with higher AKI risk, with the strongest effect observed for NO2 (RR 1.066, 95% CI 1.033–1.099). No association was found for SO2. Subgroup analyses showed consistent directions of association across sex and age groups, with NO2 remaining the most detrimental pollutant. Although statistical significance varied between pollutants, no significant effect modification by sex or age was observed (p > 0.05). Conclusions: Mid-term exposure to ambient air pollution is associated with an increased risk of AKI-related hospitalizations, with NO2 showing the strongest effects. These findings identify mid-term exposure as a relevant temporal window and support the role of air pollution as a modifiable risk factor for AKI. Full article
(This article belongs to the Special Issue Acute Kidney Injury: Current Challenges and Future Directions in Diagnosis and Treatment)
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17 pages, 2224 KB  
Systematic Review
Triglyceride–Glucose Index and Acute Kidney Injury: A Systematic Review and Meta-Analysis
by Yan-Wu Yang, Jing Yu, Li Gong, Mei-Ling Ge and Zhi Wan
J. Clin. Med. 2026, 15(9), 3390; https://doi.org/10.3390/jcm15093390 - 29 Apr 2026
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Abstract
Background: The triglyceride–glucose (TyG) index, a surrogate marker of insulin resistance, has been increasingly associated with adverse cardiometabolic outcomes. However, its relationship with acute kidney injury (AKI) across clinical settings has not been comprehensively synthesized. We performed a systematic review and meta-analysis to [...] Read more.
Background: The triglyceride–glucose (TyG) index, a surrogate marker of insulin resistance, has been increasingly associated with adverse cardiometabolic outcomes. However, its relationship with acute kidney injury (AKI) across clinical settings has not been comprehensively synthesized. We performed a systematic review and meta-analysis to evaluate the association between the TyG index and AKI risk. Methods: PubMed, Embase, and Web of Science were searched through February 2026 for observational studies reporting adjusted associations between TyG and AKI. Random-effects models were used to pool categorical and continuous effect estimates. Dose–response analyses and subgroup assessments were conducted to explore consistency. Diagnostic performance was summarized when available. Results: Thirty studies involving 518,677 participants were included. Compared with the lowest-TyG category, the highest-TyG category was associated with significantly increased AKI risk (pooled OR = 1.95, 95% CI 1.66–2.28; I2 = 72.7%). Associations were most consistently observed in cardiovascular disease cohorts (pooled OR = 1.86, 95% CI 1.44–2.40) and remained directionally similar across other clinical settings without significant subgroup interactions. Each 1-unit increment in TyG index was associated with higher AKI risk (OR = 1.48, 95% CI 1.30–1.69), and time-to-event analyses yielded concordant results (HR = 1.38, 95% CI 1.14–1.65). A significant non-linear dose–response association was observed (p < 0.001). The TyG index showed moderate discrimination (AUC = 0.74), with findings remaining robust in sensitivity analyses. Conclusions: Current evidence supports TyG primarily as a complementary metabolic risk marker rather than a substitute for established AKI diagnostic or prediction tools. TyG may serve as a practical marker for metabolic risk stratification in patients at risk of AKI. Full article
(This article belongs to the Special Issue Acute Kidney Injury: Current Challenges and Future Directions in Diagnosis and Treatment)
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