Permissive Azotemia During Acute Kidney Injury Enables More Rapid Renal Recovery and Less Renal Fibrosis: a Hypothesis and Clinical Development Plan

Overview

Journal Crit Care

Specialty Critical Care

Date 2022 Apr 28

PMID 35484549

Authors

Lakhmir S Chawla

Affiliations

Soon will be listed here.

Abstract

Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis. Similarly, significant decreases in monocyte/macrophage infiltration, complement levels, and other markers of inflammation in the injured kidney are observed across multiple studies and species. In essence, decreased renal clearance has the surprising and counterintuitive effect of being an effective treatment for AKI. In this Perspective, the author suggests a hypothesis describing why the uremic milieu is kidney protective and proposes a clinical trial of 'permissive azotemia' to improve renal recovery and long-term renal outcomes in critically ill patients with severe AKI.

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