Acute kidney Injury (AKI) is a serious medical condition affecting more than 10 million people around the world annually and resulting in poor outcomes. It has been suggested that late recognition of the syndrome may lead to delayed interventions with increased morbidity and mortality. Early diagnosis and timely therapeutic strategies may be the cornerstone of future improvement in outcomes. The purpose of this article is to provide a practical model to identify patients at high risk for AKI in different environments, with the goal to prevent AKI. We describe the AKI Risk Assessment (ARA) as a proposed algorithm that systematically evaluates the patient in high-risk situations of AKI in a simple way no matter where the patient is located, and allows different medical specialists to approach patients as a team with a nephrologist to improve outcomes. The goal of the nephrology rapid response team (NRRT) is to prevent AKI or start treatment if AKI is already diagnosed as a consequence of progressive events that can lead to progressive deterioration of kidney tissues and eventual decline in renal function and to ensure appropriate follow-up of patients at risk for progressive chronic kidney disease after the episode of AKI. Prevention is the key to avoid mortality and morbidity associated with AKI. Integration of these assessment tools in a global methodology that includes a multi-disciplinary team (NRRT) is critical to success. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452402.

Acute kidney injury (AKI) is a common condition in critically ill patients. Multiple studies have identified AKI as a strong independent risk factor for higher morbidity and mortality. AKI is often multifactorial, asymptomatic and difficult to predict. In recent years, the discovery of several AKI biomarkers, including the recent validation and approval of cell cycle arrest biomarkers (NephroCheck, Astute Medical, San Diego, CA, USA), has provided additional tools to detect patients at high risk of AKI and improve their outcomes. We propose a protocol to integrate the use of NephroCheck into a multidisciplinary rapid clinical response team to potentially reduce AKI development, severity and the number of patients who need dialysis. We have designed a stepped alarm system for nephrologists and critical care physicians that starts with the recognition of high-risk patients in the clinical setting. The evaluation of patients' clinical situation together with the NephroCheck value will lead to a list of recommendations to prevent the development of AKI or progression to acute kidney stress or injury. We propose that the routine clinical application of a NephroCheck Rapid Response Team (RRT), where the NephroCheck RRT acts under the principle of improving safety and avoiding deterioration of patients, can impact patients' well-being in a positive way.

AKI is associated with increased risk of death, prolonged length of stay and development of de-novo chronic kidney disease. The aim of our study is the development and validation of prediction models to identify the risk of AKI in ICU patients up to 7 days. We retrospectively recruited 692 consecutive patients admitted to the ICU at San Bortolo Hospital (Vicenza, Italy) from 1 June 2016 to 31 March 2017: 455 patients were treated as the derivation group and 237 as the validation group. Candidate variables were selected based on a literature review and expert opinion. Admission eGFR< 90 ml/min /1.73 mq (OR 2.78; 95% CI 1.78–4.35; p<0.001); SOFAcv ≥ 2 (OR 2.23; 95% CI 1.48–3.37; p<0.001); lactate ≥ 2 mmol/L (OR 1.81; 95% CI 1.19–2.74; p = 0.005) and (TIMP-2)•(IGFBP7) ≥ 0.3 (OR 1.65; 95% CI 1.08–2.52; p = 0.019) were significantly associated with AKI. For the q-AKI score, we stratified patients into different AKI Risk score levels: 0–2; 3–4; 5–6; 7–8 and 9–10. In both cohorts, we observed that the proportion of AKI patients was higher in the higher score levels.