Korean J Med.  2015 Apr;88(4):382-386. 10.3904/kjm.2015.88.4.382.

Acute Kidney Injury and Chronic Kidney Disease as Interconnected Syndromes

• Lee SY

• KMID: 2269121
• DOI: http://doi.org/10.3904/kjm.2015.88.4.382

Abstract

Although it was thought that survivors from an acute kidney injury (AKI) recovered kidney function completely, cumulative observational data have shown that AKI can cause end-stage renal disease directly, increase the risk of developing incident chronic kidney disease (CKD), and worsen an underlying CKD. These data have confirmed an association between AKI and an increased risk of permanent kidney damage, with subsequent development of CKD. However, many studies have focused on early injury following ischemic insult; the mechanisms of long-term injury remain poorly understood. Established and new data suggest that endothelial injury, loss of peritubular capillary volume, and chronic hypoxia affect structural changes after an ischemic insult. The repair process after acute kidney injury can be both adaptive and maladaptive. A maladaptive response includes persistent upregulation of proinflammatory and profibrotic signals and maladaptive cellular regeneration; this is thought to be one of the mechanisms leading to progressive renal injury and, ultimately, end-stage renal disease. The purpose of this brief review was to focus on recent advances related to the mechanisms of the progression from AKI to CKD. This review suggests that a new approach is required to manage AKI patients to prevent and/or arrest CKD progression.

Keyword

AKI; CKD; Endothelial injury; Chronic hypoxia; Inflammation

MeSH Terms

Acute Kidney Injury*
Anoxia
Capillaries
Humans
Inflammation
Kidney
Kidney Failure, Chronic
Regeneration
Renal Insufficiency, Chronic*
Survivors
Up-Regulation