tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.

/pdf/kdigo-clinical-practice-guidelines-for-acute-kidney-injury-27tybolw7l.pdf

KDIGO clinical practice guidelines for acute kidney injury.

For more than 40 years, nephrologists have classified diminished kidney function as two distinct syndromes — acute and chronic kidney failure. Whereas chronic kidney disease was recognized in the 19th century, acute renal dysfunction became evident during the London Blitz of World War II, with the realization that crush injuries could cause dramatic but often reversible cessation of renal function. The disease states and stages of both acute and chronic renal syndromes are delineated according to the serum creatinine concentration or the glomerular filtration rate (GFR), functional markers that were identified in the early 20th century. 1 Advanced renal impairment in both syndromes is treated with dialysis. During the past decade, separate conceptual models for chronic kidney disease 2 and acute kidney injury 3 were developed to facilitate organized approaches to clinical research and trials. However, recent epidemiologic and mechanistic studies suggest that the two syndromes are not distinct entities but rather are closely interconnected — chronic kidney disease is a risk factor for acute kidney injury, acute kidney injury is a risk factor for the development of chronic kidney disease, and both acute kidney injury and chronic kidney disease are risk factors for cardiovascular disease (Fig. 1). 4

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Acute kidney injury and chronic kidney disease as interconnected syndromes

https://www.ajkd.org/article/S0272-6386(09)00079-1/pdf

Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysis

https://www.kidney-international.org/article/S0085-2538(15)55599-3/pdf

Acute kidney injury and chronic kidney disease: An integrated clinical syndrome

https://www.kidney-international.org/article/S0085-2538(15)54748-0/pdf

The severity of acute kidney injury predicts progression to chronic kidney disease

https://www.kidney-international.org/article/S0085-2538(15)52426-5/pdf

J.-M. Sáez-de-Urturi

Papers

Long-term outcome of acute tubular necrosis: a contribution to its natural history.