Meeting the challenge of acute kidney injury

06 February 2025

We caught up with Professor Nick Selby to hear about his work acute kidney injury (AKI) and how Kidney Research UK’s biological sample and data resource NURTuRE can help support future research breakthroughs.

Thanks for talking to us today, Nick! Please can you briefly explain what AKI is?

AKI is a term that is used to describe a sudden decline in a person’s kidney function. Symptoms are variable but they can include a reduction in the volume of urine, sickness, abdominal pain and drowsiness, but in many cases AKI can be silent. This diagnosis does not always mean permanent loss of kidney function, but in all cases patients with AKI need prompt medical attention.

AKI is a complex problem. Rather than being a condition in its own right, it is a syndrome that has many different causes. A variety of factors can lead to AKI, including reduced blood flow (e.g. low blood pressure or dehydration), sepsis, heart problems, a blockage to the flow of urine or certain medications. Because AKI can develop due to problems elsewhere in the body, it is not always diagnosed promptly, and this can result in less good outcomes for the patient.

Many patients each year will be diagnosed with AKI, and very sadly not all will recover. Data from the UK Renal Registry in 2022 found that nearly 600,000 people had an episode of AKI, 19% of whom died within 30 days. We also appreciate that people who survive an episode of AKI are at increased risk of permanent reductions in kidney function (chronic kidney disease), cardiac problems and may suffer a variety of symptoms (e.g. fatigue, loss of physical functioning) related to their hospital stay. We need to do more as a community to address this.

Professor Nick Selby

Meet the researcher

Professor Nick Selby is a clinical academic at the University of Nottingham, alongside his research work and teaching, and is an honorary consultant in kidney medicine at the Royal Derby Hospital. Nick has had several research grants from Kidney Research UK and is one of the lead investigators for the new NURTuRE project looking at AKI.

How can we reduce the number of patients being diagnosed with AKI, and help ensure that more recover?

Preventing AKI is difficult as there are so many ways that it can happen, but there is much that we can do to help ensure earlier diagnosis and more effective treatment.

Lots of work has been done to improve how well AKI is identified, and we now have an alert system in place in NHS hospitals to help doctors recognise the signs of AKI earlier. Currently, the way that we test kidney function is not precise enough to support a true early warning – this is something we need to improve.

There is not yet a specific treatment for AKI patients. We try to remove or reduce the cause of the problem and then offer the patient supportive measures, such as carefully controlling fluid levels in the body and ensuring correct combinations and doses of medications. In many cases, patients will recover their kidney function, but about a quarter of people will progress to CKD and we need to learn more about how best to help this group.

It is an exciting time in kidney medicine with new treatments becoming available, and we hope that some of these innovations can benefit AKI patients. There is now some evidence to suggest that a new type of drug called SGLT2 inhibitors might help reduce the rates of AKI, but we will need more research to be sure of this.

Please could you tell us a bit more about NURTuRE and how it might help support research in AKI?

NURTuRE is a resource to support carefully-selected research in kidney disease. NURTuRE securely holds biological samples and healthcare information donated by individuals living with kidney disease. Using NURTuRE to look at data from large numbers of people may allow us to answer some of the really important questions in kidney medicine such as whether there is a way of identifying in advance who might respond best to a particular treatment, or if there is a new target for treatment that might help protect kidney function.

At the moment, NURTuRE contains information from patients with chronic kidney disease and idiopathic nephrotic syndrome (INS), but from early 2025 we will start inviting patients with AKI to join this important resource.

One of the key ways that NURTuRE can contribute to our understanding of AKI is by supporting research into new markers of the first stages of this disorder. This will support earlier diagnosis and could also provide a target for new treatment approaches, both of which would offer huge patient benefits. I also hope that we will be able to use the information in NURTuRE to learn more about what types of patients are more or less likely to recover full health following a diagnosis of AKI. If we were able to find a blood or body tissue-based way of identifying those most at risk of long-term kidney problems (known as ‘biomarkers’), this would not only help us plan care but could also present a new target for drug development.