The contrasting characteristics of acute kidney injury in developed and developing countries

Authors from India and the US have systematically reviewed the literature on acute kidney injury. Their comprehensive exploration of this condition in developing countries reveals surprising commonalities between areas that are influenced by seemingly disparate geographical, etiological and cultural factors. Determining the true incidence of acute kidney injury is key to increasing awareness of the problem in underdeveloped regions, and to initiation of efforts to prevent its occurrence. Acute kidney injury (AKI) has become increasingly prevalent in both developed and developing countries, and is associated with severe morbidity and mortality, especially in children. Uncertainty regarding the true incidence of AKI limits awareness of the problem, thereby reducing political visibility of the disorder and hampering efforts to prevent its occurrence. In developed countries, AKI occurs predominantly in urban intensive care units and is associated with multiorgan failure and sepsis, high mortality, and occurrence in older populations. While cases of AKI in urban areas of the developing world have similar characteristics to those in the developed world, AKI in rural regions commonly develops in response to a single disease and specific conditions (e.g. gastroenteritis) or infections (e.g. severe malaria, leptospirosis, or hemolytic–uremic syndrome) and in younger otherwise healthy individuals. Many causes of AKI in rural settings, such as diarrhea, poisoning, malaria, or septic abortion, can be prevented by interventions at the individual, community, and regional levels. Treatment with dialysis is often unavailable or too costly in developing regions, so there must be community-wide efforts to eradicate causes of AKI, expedite diagnosis, and aggressively manage prerenal conditions and specific infections. We have reviewed recent literature on AKI, identified differences and similarities in the condition between developed and developing areas, analyzed the practical implications of the identified differences, and made evidence-based recommendations for study and management. Key Points Acute kidney injury (AKI) is becoming increasingly prevalent, but uncertainty regarding its true incidence limits awareness, reduces the political visibility of the disorder, and hampers efforts to prevent its occurrence AKI in the developing world occurs in both urban and rural areas and often affects younger individuals who have a single disease; volume-responsive renal failure or