Carmine Zoccali

Clinical research on acute renal failure has made major progress in the last few years. The terminology is being redefined and a new interpretative framework is being tested on the basis of analyses derived from well-conceived observational studies. This week we have a quartet of excellent presentations on this issue. The kick off is by Dr. De Broe who describes the pathways whereby ischemic or toxic insults cause acute kidney injury (AKI). He starts from the early inflammatory events that characterise AKI and goes on to discuss on how ischemic cellular damage results in the release of several molecules which reduce Toll Like Receptor 4 (TLR4) activation on the dendritic cells. These cells start producing TNF-alpha, an event that precedes leukocytes accumulation in the kidney. Several drugs already exist that can interfere with factors responsible for AKI but still today prevention and treatment of AKI are largely unsatisfactory with a 50-60% mortality rate. Dr. De Broe feels that randomized trials on  nephroprotection and trials targeting at inflammation are a priority.
Dr. Danilo Fliser, Homburg/Saar, presents a well cut overview on the protective role of erythropoietin in experimental models. Studies in this area are already in the translational phase and in the last part of the lecture Dr. Fliser describes a randomised double blinded placebo controlled study in CKD5D patients undergoing kidney transplantation. In this ongoing trial 90 patients were randomized to receive a placebo or 3.000 units of erythropoietin before, within the first hour, and 3 and 7 days after transplantation. The primary study end point was serum creatinine and cystatin C or the need of dialysis 42 days after transplantation.
Dr. Schetz (Louvain) offers a nice update on the importance of proper lung ventilation in patients in intensive care units. She goes from terminology to basic physiology finally ending up by giving the clinical nephrologist an important message: be aware that lung-protective ventilation produces beneficial effects on the kidney.
Dr. Hoste (Gent) deals with sepsis, i.e. the most frequent cause of AKI in patients in intensive care units. 50% of AKI cases are indeed caused by sepsis while as much as 50% of sepsis patients will develop AKI. Dr. Ricci (Rome) refreshes basic knowledge on Acute Respiratory Distress Syndrome (ARDS). Severe forms of acute respiratory failure may represent the lung component of an early multi-organ failure. Lung-protective techniques of mechanical ventilatory support reduced mortality but long-term disability in survivors still remains considerable.

Enjoy your NDTe!

Carmine Zoccali – Editor in Chief NDT-Educational