Progress in the diagnosis and therapy of acute kidney injury and chronic kidney disease

The RIFLE classification (R – risk, I – injury, F – failure, L – loss of function, E – end-stage kidney disease), which was introduced recently for the diagnosis of acute kidney injury (AKI), instead of the term acute renal failure, represents progress from the clinical point of view. The introduction of evaluation of the biomarkers of kidney injury, particularly NGAL, permits even earlier diagnosis of AKI, already at 2 hours after the beginning of the injury, making possible early therapeutic intervention. Evaluation of the prognosis and risk of death in patients with AKI is in progress. The elimination of the cause of kidney injury, volaemic control and proper start of the renal replacement therapy with preference of continuous methods play the principal role in the treatment of AKI. Evaluation of albuminuria, urine analysis and the estimated glomerular filtration rate from the MDRD equation are the principal methods for the diagnosis of chronic kidney disease. The progress in therapy consists of: optimal blood pressure control, reduction of proteinuria, use of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers, correction of hyperphosphataemia, prevention of vitamin D depletion and elimination of all risk factors for the progression of kidney function impairment.