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New Approaches in the Treatment of Acute Kidney Injury

Acute renal insufficiency means reversible renal damage with oliguria or anuria, which is now generally called acute kidney injury (AKI) (1). Acute kidney injury presents unique, life threatening and organ threatening therapeutic challenges that require prompt, accurate diagnosis and treatment. In rare cases,AKI can also take a polyuric course. Damage to the kidneys varies depending on the degree and duration of pre-renal, renal or postrenal noxae (2–5). It is reversible only after the elimination of the noxae (in the case of structural disorders only after its repair), or it can remain irreversible. AKI is also defined as acute (over hours or days) developing renal function damage, which is measured by the glomerular filtration rate (GFR). Other renal functions are changed and decreased in AKI, such as the excretion of metabolic products and drugs, the reabsorption of filtrated substances, the regulation in acid-base and electrolyte disorders, and different endocrinological functions. The incidence of AKI is 2–5% in inpatients and up to 10–30% with intensive medical care. The mortality has essentially remained unchanged in the last four decades and, at 30 to 80%, is very high. Although in the last few years considerable progress have been made in dialysis technology and intensive medical care therapy, AKI is the most frequent and expensive renal disease with the highest course of morbidity and mortality in hospitals (6).