Subphenotypes in acute kidney injury: a narrative review
Suvi T. Vaara,
Pavan K. Bhatraju,
Natalja L. Stanski,
Blaithin A. McMahon,
Kathleen Liu,
Michael Joannidis,
Sean M. Bagshaw
Affiliations
Suvi T. Vaara
Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, Meilahti Hospital, University of Helsinki and Helsinki University Hospital
Pavan K. Bhatraju
Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington
Natalja L. Stanski
Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
Blaithin A. McMahon
Division of Nephrology, Department of Medicine, Medical University of South Carolina
Kathleen Liu
Divisions of Nephrology and Critical Care, Departments of Medicine and Anesthesia, University of California
Michael Joannidis
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck
Sean M. Bagshaw
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services
Abstract Acute kidney injury (AKI) is a frequently encountered syndrome especially among the critically ill. Current diagnosis of AKI is based on acute deterioration of kidney function, indicated by an increase in creatinine and/or reduced urine output. However, this syndromic definition encompasses a wide variety of distinct clinical features, varying pathophysiology, etiology and risk factors, and finally very different short- and long-term outcomes. Lumping all AKI together may conceal unique pathophysiologic processes specific to certain AKI populations, and discovering these AKI subphenotypes might help to develop targeted therapies tackling unique pathophysiological processes. In this review, we discuss the concept of AKI subphenotypes, current knowledge regarding both clinical and biomarker-driven subphenotypes, interplay with AKI subphenotypes and other ICU syndromes, and potential future and clinical implications.
