Apparent full recovery from AKI is far from benign in humans. The risk of progression to CKD is significant. Practitioners do not monitor for this complication and definitely not has means to prevent that. Understanding the pathophysiologic mechanism of AKI-to-CKD progression is of the utmost importance in terms of risk stratification, detection, and prevention.
Two of many mechanisms that contribute to progression are (1) the disintegration of the renal vasculature leading to chronic under-perfusion, and (2) phosphate-induced impairment of autophagy. These studies are being pursued with animal models with genetic ad pharmacologic manipulations and human observations in a post-AKI study using biomarkers and functional MRI.