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Fig. 2.

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Fig. 2.

Revised conceptual model for AKI. White and light grey circles represent antecedents of AKI, i.e. patients at risk with suspected sepsis or those undergoing cardiac surgery. Acute kidney stress is defined as the preinjury phase that may transition into AKI. Sustained kidney stress will mitigate renal functional reserve and eventually transition into any variation of structural and functional kidney impairment (BM+/SCr-, BM-/SCr+, BM+/SCr+, and AKI-RRT). Structural kidney injury is indicated by a positive BM (+) finding. Arrows between the circles show potential transitions between AKI stages. AKI requiring RRT or patient death are associated adverse outcomes. Grey variations of the circles for kidney risk, kidney stress, and structural or functional kidney injury reflect increasing risk of adverse events [75, 93].

Abbreviations: AKI, acute kidney injury; SCr, serum creatinine; GFR, glomerular filtration rate; RFR, renal functional reserve; RRT, renal replacement therapy; BM, biomarker.

Low risk for event Risk for event (observation zone), potential “kidney-stress”, “preclinical” or “subclinical” AKI Severe risk for event Critical risk for event

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