Reviews cover a clinical, translational, or basic science topic of interest to practitioners and describe the treatment, diagnosis, or pathogenesis of a disease process or its complications, emphasizing recent advances in the field.
- The optimal timing of kidney support therapy in critically ill patients with acute kidney injury (AKI) without life-threatening complications related to AKI is controversial. Recent multicenter, randomized, controlled studies have questioned the need for earlier initiation of therapy, despite one study showing a benefit in survival and others with no differences in mortality based on the timing of kidney support therapy initiation. These findings reflect the uncertainties in decisions to initiate kidney support therapy, which should ideally be individualized according to the patient’s comorbidities, severity of illness, trajectory of kidney function, and urine output as well as requirements for fluid balance and solute removal.
- Acute kidney injury (AKI) is one of the most common and morbid complications of decompensated cirrhosis. Management of AKI is dictated by cause: prerenal AKI is treated with volume resuscitation; hepatorenal syndrome (HRS), with intravenous albumin and vasoconstrictors; and acute tubular necrosis, with supportive care. However, differentiating between causes is difficult using creatinine-based definitions of AKI alone. The use of novel kidney biomarkers in AKI and cirrhosis provides an opportunity to improve both the diagnosis and prognosis of this vulnerable population.
- Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Dysfunction of other organs is an important cause of poor outcomes from AKI. Ample clinical and epidemiologic data show that AKI is associated with distant organ dysfunction in lung, heart, brain, and liver. Recent advancements in basic and clinical research have demonstrated physiologic and molecular mechanisms of distant organ interactions in AKI, including leukocyte activation and infiltration, generation of soluble factors such as inflammatory cytokines/chemokines, and endothelial injury.
- Colistin (polymyxin E) is a mainly concentration-dependent bactericidal antimicrobial active against multidrug-resistant Gram-negative bacteria. After being abandoned over the past 30 years due to its neuro- and nephrotoxicity, colistin has been reintroduced recently as a last-resort drug for the treatment of multidrug-resistant Gram-negative bacteria infections in combination with other antimicrobials. Unfortunately, although renal toxicity is a well-known dose-related adverse effect of colistin, relatively few studies are currently available on its peculiar pharmacodynamic/pharmacokinetic properties in clinical settings at high risk for drug accumulation, such as acute or chronic kidney disease.