Acute kidney injury and disease: Long-term consequences and management

With increasing longevity and the presence of multiple comorbidities, a significant proportion of hospitalized patients, and an even larger population in the community, is at increased risk of developing an episode of acute kidney injury (AKI). Because of improvements in short-term outcomes following an episode of AKI, survivors of an episode of AKI are now predisposed to develop its long-term sequel. The identification of risk for progression to chronic kidney disease (CKD) is complicated by the absence of good biomarkers that identify this risk and the variability of risk associated with clinical factors including, but not limited to, the number of AKI episodes, severity, duration of previous AKI and pre-existing CKD that has made the prediction for long-term outcomes in survivors of AKI more difficult. Being a significant contributor to the growing incidence of CKD, there is a need to implement measures to prevent AKI in both the community and hospital settings, target interventions to treat AKI that are also associated with better long-term outcomes, accurately identify patients at risk of adverse consequences following an episode of AKI and institute therapeutic strategies to improve these long-term outcomes. We discuss the lasting renal and non-renal consequences following an episode of AKI, available biomarkers and non-invasive testing to identify ongoing intra-renal pathology and review the currently available and future treatment strategies to help reduce these adverse long-term outcomes. There is an imminent need to increase awareness among general physicians about the long term risk of an episode of AKI and the improved outcomes with early referral and follow up by a nephrologist. This review highlights the importance of recognising the renal and non-renal consequences following an episode of AKI, and the available biomarkers for this condition.