{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:05:06Z","timestamp":1792803906654,"version":"4.5.0"},"reference-count":354,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Agency of Scientific Research, and Innovation (NASRI), Albania","award":["1005\/8"],"award-info":[{"award-number":["1005\/8"]}],"id":[{"id":"https:\/\/ror.org\/05pzdvf58","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Acute kidney injury (AKI) is a frequent and severe complication in trauma patients, affecting up to 28% of intensive care unit (ICU) admissions and contributing significantly to morbidity, mortality, and long-term renal impairment. Trauma-related AKI (TRAKI) arises from diverse mechanisms, including hemorrhagic shock, ischemia\u2013reperfusion injury, systemic inflammation, rhabdomyolysis, nephrotoxicity, and complex organ crosstalk involving the brain, lungs, and abdomen. Pathophysiologically, TRAKI involves early disruption of the glomerular filtration barrier, tubular epithelial injury, and renal microvascular dysfunction. Inflammatory cascades, oxidative stress, immune thrombosis, and maladaptive repair mechanisms mediate these injuries. Trauma-related rhabdomyolysis and exposure to contrast agents or nephrotoxic drugs further exacerbate renal stress, particularly in patients with pre-existing comorbidities. Traditional markers such as serum creatinine (sCr) are late indicators of kidney damage and lack specificity. Emerging structural and stress response biomarkers\u2014such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), C-C motif chemokine ligand 14 (CCL14), Dickkopf-3 (DKK3), and the U.S. Food and Drug Administration (FDA)-approved tissue inhibitor of metalloproteinases-2 \u00d7 insulin-like growth factor-binding protein 7 (TIMP-2 \u00d7 IGFBP-7)\u2014allow earlier detection of subclinical AKI and better predict progression and the need for renal replacement therapy. Together, functional indices like urinary sodium and fractional potassium excretion reflect early microcirculatory stress and add clinical value. In parallel, risk stratification tools, including the Renal Angina Index (RAI), the McMahon score, and the Haines model, enable the early identification of high-risk patients and help tailor nephroprotective strategies. Together, these biomarkers and risk models shift from passive AKI recognition to proactive, personalized management. A new paradigm that integrates biomarker-guided diagnostics and dynamic clinical scoring into trauma care promises to reduce AKI burden and improve renal outcomes in this critically ill population.<\/jats:p>","DOI":"10.3390\/diagnostics15192438","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T07:46:49Z","timestamp":1758786409000},"page":"2438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Kidneys on the Frontline: Nephrologists Tackling the Wilds of Acute Kidney Injury in Trauma Patients\u2014From Pathophysiology to Early Biomarkers"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1048-2579","authenticated-orcid":false,"given":"Merita","family":"Rroji","sequence":"first","affiliation":[{"name":"Department of Nephrology, University of Medicine, 1005 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1378-3792","authenticated-orcid":false,"given":"Marsida","family":"Kasa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital of Trauma, 1000 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8515-8143","authenticated-orcid":false,"given":"Nereida","family":"Spahia","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of Medicine, 1005 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saimir","family":"Kuci","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, University of Medicine, 1005 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Ibrahimi","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, University of Medicine, 1005 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hektor","family":"Sula","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, University of Medicine, 1005 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jss.2022.12.001","article-title":"Predisposing Factors and Outcome of Acute Kidney Injury After Blunt Trauma: A 10-Year Study","volume":"284","author":"Ramzee","year":"2023","journal-title":"J. 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