A recuperação em casos de lesão renal aguda (LRA) é variável e depende da causa da lesão e da gravidade e duração da LRA.[149]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67.
https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com
[150]Mehta S, Chauhan K, Patel A, et al. The prognostic importance of duration of AKI: a systematic review and meta-analysis. BMC Nephrol. 2018 Apr 19;19(1):91.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907696
http://www.ncbi.nlm.nih.gov/pubmed/29673338?tool=bestpractice.com
Há uma associação independente da LRA com um risco maior de morte.[9]Wang HE, Muntner P, Chertow GM, et al. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol. 2012;35(4):349-55.
https://www.karger.com/Article/FullText/337487
http://www.ncbi.nlm.nih.gov/pubmed/22473149?tool=bestpractice.com
[149]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67.
https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com
[151]Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: systematic review and meta-analysis. Am J Kidney Dis. 2009 Jun;53(6):961-73.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726041
http://www.ncbi.nlm.nih.gov/pubmed/19346042?tool=bestpractice.com
Taxas de mortalidade intra-hospitalar associadas a LRA variam de 6% a 80%, e há um aumento da mortalidade em longo prazo em pessoas com LRA que sobrevivem após hospitalização.[151]Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: systematic review and meta-analysis. Am J Kidney Dis. 2009 Jun;53(6):961-73.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726041
http://www.ncbi.nlm.nih.gov/pubmed/19346042?tool=bestpractice.com
Até 6% dos pacientes internados em unidades de terapia intensiva (UTI) apresentam LRA que requer terapia renal substitutiva (TRS).[16]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
[149]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67.
https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com
[152]Tao Li PK, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Int J Organ Transplant Med. 2013;4(1):1-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089304
http://www.ncbi.nlm.nih.gov/pubmed/25013646?tool=bestpractice.com
No hospital, quando a LRA requer diálise, a mortalidade excede 50%, especialmente nos quadros com insuficiência de múltiplos órgãos.[13]Mehta R, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21.
http://www.ncbi.nlm.nih.gov/pubmed/15458458?tool=bestpractice.com
[16]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
[152]Tao Li PK, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Int J Organ Transplant Med. 2013;4(1):1-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089304
http://www.ncbi.nlm.nih.gov/pubmed/25013646?tool=bestpractice.com
As taxas de mortalidade são altas por conta da morte decorrente de doença subjacente e complicações, não apenas por LRA.
Em pacientes com LRA que requer TRS, as taxas de sobrevida em cinco anos variam de 15% a 35% (menos de 10% desses pacientes são dependentes de diálise).[153]Rimes-Stigare C, Awad A, Mårtensson J, et al. Long-term outcome after acute renal replacement therapy: a narrative review. Acta Anaesthesiol Scand. 2012 Feb;56(2):138-46.
http://www.ncbi.nlm.nih.gov/pubmed/22092145?tool=bestpractice.com
A LRA é irreversível em aproximadamente 5% a 7% dos adultos e em até 16% dos pacientes idosos.[154]Bhandari S, Turney JH. Survivors of acute renal failure who do not recover renal function. QJM. 1996 Jun;89(6):415-21.
http://www.ncbi.nlm.nih.gov/pubmed/8758044?tool=bestpractice.com
Há controvérsia sobre se uma LRA prévia é um fator de risco importante que leve a doença renal crônica futura, mas as evidências favorecem cada vez mais uma associação forte.[155]Rifkin DE, Coca SG, Kalantar-Zadeh K. Does AKI Truly Lead to CKD? J Am Soc Nephrol. 2012 Jun;23(6):979-84.
http://www.ncbi.nlm.nih.gov/pubmed/22460531?tool=bestpractice.com
[156]Leung KC, Tonelli M, James MT. Chronic kidney disease following acute kidney injury: risk and outcomes. Nat Rev Nephrol. 2013 Feb;9(2):77-85.
http://www.ncbi.nlm.nih.gov/pubmed/23247572?tool=bestpractice.com
[157]Bucaloiu ID, Kirchner HL, Norfolk ER, et al. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012 Mar;81(5):477-85.
http://www.ncbi.nlm.nih.gov/pubmed/22157656?tool=bestpractice.com
[158]See EJ, Jayasinghe K, Glassford N, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019 Jan;95(1):160-72.
https://www.kidney-international.org/article/S0085-2538(18)30643-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/30473140?tool=bestpractice.com