Bimodal distribution of trauma-related acute kidney injury (TrAKI): A clinical review

TL;DR

This paper reviews how trauma-related acute kidney injury occurs in two phases and highlights the importance of early diagnosis and prevention.

Contribution

The paper introduces a bimodal pathophysiological framework for understanding trauma-related acute kidney injury.

Findings

TrAKI occurs in two phases: early (24–72 hours) and late (5–7 days or later).

Early TrAKI is linked to resuscitation procedures, while late TrAKI results from critical care complications.

Recognizing these phases can improve prevention and treatment strategies.

Abstract

Severe trauma remains the leading cause of mortality and disability among young adults. Trauma-related Acute Kidney Injury (TrAKI) has been associated with worse outcomes, increased healthcare costs, and higher morbidity among survivors. The review aims to evaluate, from a pathophysiological perspective, the risk factors for TrAKI at different time points of trauma treatment, highlighting the need for early diagnosis of the syndrome and the implementation of preventive measures.

TrAKI is triggered at the time the injury occurs and further worsened by factors related to resuscitation process and potential complications. Severe trauma, due to hemorrhagic shock, is considered to act as the first hit. All subsequent necessary lifesaving procedures applied in trauma management, such as fluid resuscitation, massive transfusion and emergency surgery, could act as second hit, triggering “early” TrAKI, within 24–72 hours, due to renal hypoperfusion, hypoxia and reperfusion injury (R/I). The following critical care treatment, seems to act as the final third hit, resulting in “late” TrAKI appeared in 5–7 days or even later, caused by distal complications.

The incidence of TrAKI shows a biphasic pattern, with an “early “peak within 2–3 days after trauma, and a “delayed” occurring a week or later. This distinction could be of clinical importance because of its disparate pathophysiology and outcome. Early recognition of risk factors and diagnosis of TrAKI could improve the application of preventive measures and therapeutic treatment, reducing its prevalence.

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