Acute Kidney Injury and CKD: Chicken or Egg?

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Presentation transcript:

Acute Kidney Injury and CKD: Chicken or Egg? Michael Bedford, MBBS, Christopher Farmer, MD, Adeera Levin, MD, Tariq Ali, MD, Paul Stevens, FRCP American Journal of Kidney Diseases Volume 59, Issue 4, Pages 485-491 (April 2012) DOI: 10.1053/j.ajkd.2011.09.010 Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Conceptual model of glomerular filtration rate (GFR) and cellular pathology over time in acute kidney injury (AKI), chronic kidney disease (CKD), and AKI and CKD. (A) The cellular phases of AKI leading to repair, highlighting the possibility of initiating a self-perpetuating cycle of inflammation producing fibrosis leading to CKD. (B) The phases of cellular injury in CKD. After an initial insult, there is initiation of the inflammatory response with repair. This then may lead to the extension phase with added fibrosis. Past a point of no return, the disease process embarks on a self-perpetuating cycle of cellular damage and fibrosis (maintenance phase) leading to deterioration in GFR and progression to end-stage renal disease. The figure also shows the effect of intervention on the disease process. (C) The effect of episodes of AKI on the progression of CKD with 3 possible outcomes; complete recovery, stepwise progression, and inexorable decline. American Journal of Kidney Diseases 2012 59, 485-491DOI: (10.1053/j.ajkd.2011.09.010) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Conceptual model of glomerular filtration rate (GFR) and cellular pathology over time in acute kidney injury (AKI), chronic kidney disease (CKD), and AKI and CKD. (A) The cellular phases of AKI leading to repair, highlighting the possibility of initiating a self-perpetuating cycle of inflammation producing fibrosis leading to CKD. (B) The phases of cellular injury in CKD. After an initial insult, there is initiation of the inflammatory response with repair. This then may lead to the extension phase with added fibrosis. Past a point of no return, the disease process embarks on a self-perpetuating cycle of cellular damage and fibrosis (maintenance phase) leading to deterioration in GFR and progression to end-stage renal disease. The figure also shows the effect of intervention on the disease process. (C) The effect of episodes of AKI on the progression of CKD with 3 possible outcomes; complete recovery, stepwise progression, and inexorable decline. American Journal of Kidney Diseases 2012 59, 485-491DOI: (10.1053/j.ajkd.2011.09.010) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Definitions of kidney disease and their overlapping relationship. Estimated glomerular filtration rate (GFR [mL/min/1.73 m2] assessed from measured or estimated GFR) does not reflect measured GFR as accurately in acute kidney injury (AKI) as in chronic kidney disease (CKD). Abbreviation: SCr, serum creatinine. Adapted from the KDIGO (Kidney Disease: Improving Global Outcomes) AKI guidelines,26 with permission of KDIGO. American Journal of Kidney Diseases 2012 59, 485-491DOI: (10.1053/j.ajkd.2011.09.010) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions