ACUTE KIDNEY INJURY: PATHOPHYSIOLOGY, BIOMARKERS, AND MANAGEMENT (NARRATIVE REVIEW WITH SYSTEMATIC SEARCH ELEMENTS)

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Elektronische Zeitschriftbibliotek Logo Bielefeld Academic Search Engine Logo Erfolgreich durch internationale Zusammenarbeit INTERNAL MEDICIN Cite as: Archiv EuroMedica. 2025. 15; 4. DOI 10.35630/2025/15/4.026 Received 2 August 2025; Accepted 8 September 2025; Published 15 September 2025 ACUTE KIDNEY INJURY: PATHOPHYSIOLOGY, BIOMARKERS, AND MANAGEMENT (NARRATIVE REVIEW WITH SYSTEMATIC SEARCH ELEMENTS) ‌Michał Wabiszczewicz¹ email orcid id logo, Albert Lompart² orcid id logo, Albert Kosarewicz³ orcid id logo, Łukasz Woźniak⁴ orcid id logo, Patrycja Krysiak⁵ orcid id logo ¹Medunit Primary Care Clinic, Gdańsk, Poland ²Saint Wojciech Hospital, Gdańsk, Poland ³University Clinical Centre of Gdańsk Medical University, Gdańsk, Poland ⁴West Pomeranian Center for the Treatment of Severe Burns and Plastic Surgery, Gryfice, Poland ⁵Medical University of Łódź, Łódź, Poland download article (pdf) [email protected] ABSTRACT Background: Acute kidney injury (AKI) is a common complication with high morbidity and mortality, especially in intensive care. Early recognition remains difficult as current standards rely on delayed indicators such as serum creatinine and urine output. Aims: This review summarises recent evidence on AKI, focusing on pathophysiology, classification systems, biomarkers, management strategies, and future research priorities. Materials and Methods: A structured narrative review of the English-language literature (2015-2025) was conducted in PubMed/MEDLINE with supplementary searches in Google Scholar. Eligible studies included randomized trials, systematic reviews, meta-analyses, original research, and narrative or consensus reviews. Priority was given to large multicentre studies, systematic reviews, and biomarker evaluations. No formal risk-of-bias assessment or meta-analysis was undertaken. Results: Hospital incidence is about 5-7.5% overall and 30-60% in intensive care. Mechanistic studies implicate ischemic, toxic, inflammatory, and maladaptive repair processes, including regulated cell death pathways such as ferroptosis. KDIGO criteria remain the standard but rely on delayed functional markers. Novel biomarkers (e.g. NGAL, KIM-1, TIMP-2/IGFBP7, IL-18, CCL14) improve early detection and risk stratification. Management centres on balanced fluid strategies, individualised timing of renal replacement therapy, and evaluation of targeted interventions. Conclusions: Early recognition before functional decline is essential. Integrating validated biomarkers with precision fluid management and tailored renal replacement therapy may improve outcomes. Implementation requires cost-effective assays and context-specific care, particularly in low-resource settings. Future multicentre studies should refine biomarker-guided protocols and evaluate emerging pharmacologic and regenerative therapies. Keywords: acute kidney injury, biomarkers, pathophysiology, classification, treatment, KDIGO, Acute Disease Quality Initiative, renal replacement therapy,