Strategies to minimize acute kidney injury

Although the understanding of the causes, mechanisms and early diagnostic biomarkers of acute kidney injury (AKI) is improving, the disease's occurrence, short-term and long-term complications are diffcult to prevent. We propose three updated strategies to preserve kidney function and minimize further kidney injury in patients with AKI. These include fluid management, kidney support during advanced AKI, use of renin-angiotensin system antagonists, and use of diuretics to achieve adequate control of intravascular volume. In addition, we describe the clinical implications of the effect of fluid restriction, the choice of fluid solutions and time to initiate par-enteral nutrition. Finally, we update the timing of dialysis initiation, and weaning from dialysis. Although therapies for ameliorating AKI per se remain limited, the potentially powerful strategies could modulate the intensity and poor outcome of AKI.