Early intervention in acute kidney injury.

The prevalence of acute kidney injury (AKI) in the US is increasing, which can be attributed in part to the aging population and the pandemic of obesity, diabetes and hypertension. Individuals over the age of 70 years constitute 7% of the US population, but account for 36-70% of AKI cases. Presently, major efforts are underway to enable the early detection of AKI by use of various innovative biomarkers, thereby facilitating early intervention. Now is the time, therefore, to consider potential interventions to attenuate or prevent AKI. Several randomized studies have failed to alter the course of AKI, but these studies have been complicated by extrarenal consequences, which could have obscured the potential intrarenal benefit of the agent. Thus, agents that have exclusive effects on renal hemodynamics and tubular function, or the intrarenal infusion of short-acting agents that do not have systemic effects, need to be considered in future studies for the prevention of AKI.