Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 May;25(5):877-83.
doi: 10.1681/ASN.2013070780. Epub 2014 Jan 30.

Challenges and advances in the treatment of AKI

Gur P Kaushal  1 , Sudhir V Shah  2
Affiliations
Review

Challenges and advances in the treatment of AKI

Gur P Kaushal et al. J Am Soc Nephrol. 2014 May.

Abstract

Treating or preventing AKI requires treating or preventing a rise in serum creatinine as well as the immediate and remote clinical consequences associated with AKI. Because a substantial number of patients with AKI progress to ESRD, identifying patients likely to progress and halting progression are important goals for treating AKI. Many therapies for AKI are being developed, including RenalGuard Therapy, which aims to maintain high urine output; α-melanocyte-stimulating hormone, with anti-inflammatory and antiapoptotic activities; alkaline phosphatase, which detoxifies proinflammatory substances; novel, small interfering RNA, directed at p53 activation; THR-184, a peptide agonist of bone morphogenetic proteins; removal of catalytic iron, important in free-radical formation; and cell-based therapies, including mesenchymal stem cells in vivo and renal cell therapy in situ. In this review, we explore what treatment of AKI really means, discuss the emerging therapies, and examine the windows of opportunity for treating AKI. Finally, we provide suggestions for accelerating the pathways toward preventing and treating AKI, such as establishing an AKI network, implementing models of catalytic philanthropy, and directing a small percentage of the Medicare ESRD budget for developing therapies to prevent and treat AKI and halt progression of CKD.

Keywords: acute kidney injury; emerging therapies; end-stage kidney disease.

PubMed Disclaimer

References

    1. Star RA, Rajora N, Huang J, Stock RC, Catania A, Lipton JM: Evidence of autocrine modulation of macrophage nitric oxide synthase by alpha-melanocyte–stimulating hormone. Proc Natl Acad Sci U S A 92: 8016–8020, 1995 - PMC - PubMed
    1. Chiao H, Kohda Y, McLeroy P, Craig L, Housini I, Star RA: Alpha-melanocyte–stimulating hormone protects against renal injury after ischemia in mice and rats. J Clin Invest 99: 1165–1172, 1997 - PMC - PubMed
    1. Doi K, Hu X, Yuen PST, Leelahavanichkul A, Yasuda H, Kim SM, Schnermann J, Jonassen TE, Frøkiaer J, Nielsen S, Star RA: AP214, an analogue of alpha-melanocyte–stimulating hormone, ameliorates sepsis-induced acute kidney injury and mortality. Kidney Int 73: 1266–1274, 2008 - PMC - PubMed
    1. Steinbruchel D, Kirkegaard H, Beckert M, Nielsen S, Pallesen PA: AP214 improves long-term (3 month) outcome on composite endpoint of death, renal replacement therapy or reduced kidney function in patients undergoing cardiac surgery in a phase 2 clinical trial. [abstract] Clin J Am Soc Nephrol 22: 184A, 2011
    1. ClinicalTrials.gov: A safety and efficacy trial of multiple dosing regimens of ABT-719 for the prevention of acute kidney injury in subjects undergoing high risk cardiac surgery. NCT01777165 Jan 24, 2013. Available at: http://clinicaltrials.gov/ct2/show/NCT01777165 Accessed February 1, 2013