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World J Nephrol. Mar 6, 2016; 5(2): 139-146
Published online Mar 6, 2016. doi: 10.5527/wjn.v5.i2.139
Major comorbid disease processes associated with increased incidence of acute kidney injury
Salwa Farooqi, Jeffrey G Dickhout
Salwa Farooqi, Faculty of Health Sciences, McMaster University and St. Joseph’s Healthcare Hamilton, Ontario L8N 4A6, Canada
Jeffrey G Dickhout, Department of Medicine, Division of Nephrology, McMaster University and St. Joseph’s Healthcare Hamilton, Ontario L8N 4A6, Canada
Author contributions: Both authors equally contributed in the synthesis of this paper.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jeffrey G Dickhout, PhD, Department of Medicine, Division of Nephrology, McMaster University and St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Ontario L8N 4A6, Canada. jdickhou@stjosham.on.ca
Telephone: +1-905-5221155 Fax: +1-905-5406589
Received: September 12, 2015
Peer-review started: September 13, 2015
First decision: November 7, 2015
Revised: November 23, 2015
Accepted: January 27, 2016
Article in press: January 29, 2016
Published online: March 6, 2016
Processing time: 171 Days and 11.2 Hours
Abstract

Acute kidney injury (AKI) is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodeficiency virus (HIV) acquired immune deficiency syndrome (AIDS). This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including: Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.

Keywords: Acute kidney injury; Kidney disease; Human immunodeficiency virus; Co-morbidities; Diabetes; Cancer; Cardiac surgery; Acquired immune deficiency syndrome; Risk factors; Immune response; Cardiovascular disease

Core tip: In order to prevent, diagnose, and prophylactically treat patients, healthcare providers must identify co-morbidities that significantly increase the likelihood of acute kidney injury (AKI). Any treatments that compromise cardiac output, renal perfusion pressure, and glomerular hemodynamics risk ischemic injury to the kidney. The innate and adaptive immune responses, which are activated by renal epithelial cell necrosis contribute to the progression of AKI. These factors have been shown to be enhanced in diabetes, cancer, cardiac surgery and human immunodeficiency virus acquired immune deficiency syndrome patients.