Acute nierschade

Stand van zaken
David Hageman, Jeroen P. Kooman, Marcus D. Lancé, L.W. Ernst van Heurn en Maarten G.J. Snoeijs

Acute kidney injury

  • ‘Acute kidney injury’ is modern terminology for a sudden decline in kidney function, and is defined by the RIFLE classification (RIFLE is an acronym for Risk, Injury, Failure, Loss and End-stage kidney disease).

  • Acute kidney injury occurs as a result of the combination of reduced perfusion in the kidney, systemic inflammation, and the administration of nephrotoxic drugs.

  • Patients with chronic renal damage, advanced age, diabetes mellitus or heart failure are at an increased risk of acute kidney injury.

  • In the short term, acute kidney injury leads to a markedly increased risk of death; the long-term effect of acute kidney injury is a permanent loss of renal microcirculation which could result in chronic renal disease.

  • Certain biomarkers in the urine offer new possibilities for detecting acute kidney injury in its early stage.

  • Treatment of patients with acute kidney injury is currently supportive in nature. The optimisation of a patient’s haemodynamics results in a reduction of the occurrence of acute kidney injury during extensive surgical procedures.

  • A promising treatment aimed at preventing acute kidney injury is called ‘remote ischaemic pre-conditioning’.

  • Conflict of interest and financial support: a disclosure form provided by the author is available along with the full text of this article at; search for A5057, click on ‘Belangenverstrengeling’ (‘Conflict of interest’).