However, this may not indicate the outcomes of AKI in Japan are worse than other counties such as US and AU/NZ. We need to clarify the lowest dose that will not reduce the effects of RRT for AKI. TERADA YOSHIO, OODE KAZU, MATSUMOTO TATSUKI, TANIGUCHI YOSHINORI, HORINO TARO Department of Endocrinology,

Metabolism and Nephrology, Kochi Medical School, Kochi Univesity, Japan Acute kidney injury (AKI) is common in hospitalized patients and is associated with significant morbidity and mortality especially in critically ill condition. Unfortunately, prevention trials of AKI are especially difficult to conduct. Attention JAK inhibitor should be given to assessment of volume status and fluid administration because volume depletion is a common and modifiable risk factor for AKI. Prevention or prompt management of complications like fluid overload, hyperkalemia and metabolic acidosis improves outcomes. Immediate initiation of renal replacement therapy is indicated in the presence of life threatening changes in fluid, electrolyte and acid-base balance. Other measures like treating the underlying

cause of AKI, adapting dosage of drugs to renal function, treatment of infections and providing adequate nutrition is important. In the recent Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline (2012), the use of diuretics, low-dose dopamine, ANP is not suggested for the treatments of AKI. Diuretics are frequently used in patients HCS assay at risk of AKI and in the management of these who develop Alanine-glyoxylate transaminase AKI. Since fluid overload in one of the major

symptoms of AKI. However, diuretics can also be harmful, by reducing the circulating volume excessively and adding a prerenal insult, worsening established AKI. Therefore, it is essential to evaluate usefulness of diuretics to improve outcome of AKI, not just fluid management. Dopamine was once commonly used for renal protection in the critically ill. However, because of the multiple negative studies, its use has been abandoned by most. Doppler ultrasound study found that dopamine significantly increased renal vascular resistance in AKI patients. The KDIGO guideline recommended not using low-dose dopamine to prevent or treat AKI. Several natriuretic pepetide are in clinical use or in development for treatment of congestive heart failure or renal dysfunction, and could potentially be useful to prevent or treat AKI. However, there have been several negative studies of prophylactic ANP therapy, ANP failed to prevent primary renal transplant dysfunction and ANP prophylaxis also failed prevent contrast-induced AKI. As mentioned above, besides renal replacement therapy, no other supportive measures are available for patients with AKI.