Emerging therapeutic strategies for acute kidney injury: a new dawn in renal medicine

Acute kidney injury (AKI) is a complex and multifactorial syndrome associated with significant morbidity, mortality, and progression to chronic kidney disease.While conventional diagnostic and therapeutic strategies have centered on serum creatinine and supportive care including kidney replacement therapy (KRT), recent advances have expanded our understanding of AKI pathophysiology and treatment.This review outlines current insights into the cellular and molecular mechanisms underlying AKI, including ischemia-reperfusion injury, oxidative stress, endothelial dysfunction, and regulated necrosis.Building upon these mechanisms, emerging pharmacologic interventions, such as anti-inflammatory agents, antioxidants, growth factors, and hemodynamic modulators, show promise in preclinical and early-phase clinical studies.Regenerative therapies using mesenchymal stromal cells and extracellular vesicles represent novel cell-based strategies, while biomarker-guided precision medicine offers a paradigm shift in AKI diagnosis, risk stratification, and treatment selection.Moreover, innovations in KRT, including prolonged intermittent therapies, cytokine adsorption, and bioengineered membranes, aim to enhance solute clearance and hemodynamic stability.The integration of artificial intelligence, machine learning, and clinical decision support systems into AKI care pathways provides new opportunities for early detection and personalized intervention.Lastly, multiomics approaches are redefining AKI subphenotypes and uncovering novel therapeutic targets through comprehensive molecular profiling.Continued research and precision-based clinical trials are essential to realize the full therapeutic potential of these innovations in AKI management.