Adaptation in Acute Kidney Injury
It is well established that patients who develop acute kidney injury (AKI) are at increased risk for progression to chronic kidney disease (CKD). However, by the time AKI is clinically recognized, a sequence of events with potential to repair the injury or propagate further damage to the renal parenchyma is already initiated. The outcome of the repair process depends on adaptive and maladaptive influences at the cellular level. Progression to CKD after AKI is the result of imbalance in favor of maladaptive repair, which culminates in the development of interstitial fibrosis. Various biochemical pathways are implicated in this process and may lend themselves to potential therapeutic targets for intervention in the transition from AKI to CKD. Emerging methods, including injury-specific biomarkers for the earlier detection of subclinical disease, show promise for use in combination with clinical factors and functional markers to stratify patient risk for CKD progression after AKI.