Update on recent hot issues and progress of acute kidney injury

Acute kidney injury（AKI）is a public health disease worldwide. According to global prospective observations，the incidence of AKI in adults and children was 39% and 53%，respectively. Some newly classified regulated tubular cell necrosis are essential mechanism in severe AKI，including necroptosis，ferroptosis and pyroptosis. After severe injury，cell cycle arrest，mitochondrial damage， Wnt and P53 signal abnormalities，microcirculation disturbance，hypoxia，immune cell polarization and renal tubular epithelial transdifferentiation can cause decompensated repair of renal tubular epithelium. These pathological repairs result in chronicity of AKI. Although a batch of AKI markers for early diagnosis and long-term prognosis have been certified in European and American countries，these markers are still far from clinical application. Multiple markers or microarrays is alternative direction，in spit of cost limitation. Utilization of electronic medical data is another strategy to enhance AKI management. Based on it，electronic alert system and cluster management platform can be conducted，which will facilitate the comprehensive management of AKI in the future. Initiation timing and dosing of kidney replacement therapy（KRT）in serve AKI has not reached consensus. No evidence supports that early，high-dose continuous replacement therapy（dose>20 mL·kg^-1·h^-1）or frequent intermittent KRT（more than 3 times per week）benefits clinically. AKI is also a common complication in patients with COVID-19 infection. The pathological changes are focal segmental sclerosis and acute tubular necrosis. AKI increases mortality and requires adequate supportive care if it occurs.