Translating Acute Kidney Injury to Chronic Kidney Disease: Biomarkers, Therapeutic Strategies, and Prognostic Implications for Renal Outcomes

Acute kidney injury (AKI) has emerged as a critical precursor of chronic kidney disease (CKD), leading to significant morbidity and healthcare burden globally. This review synthesizes current knowledge on the mechanistic pathways driving AKI-to-CKD transition, including inflammatory responses, fibrosis, vascular injury, and epigenetic regulation. Age, sex, and genetic predispositions further modulate this progression, with comorbidities like diabetes and hypertension exacerbating risk. We discuss advances in biomarkers, spanning serum, urinary, genetic, and imaging modalities, that enhance early detection and prognostication. Therapeutic strategies encompass pharmacological agents targeting renin-angiotensin and sodium-glucose cotransporter pathways, anti-inflammatory and anti-fibrotic treatments, and lifestyle interventions. Prognostic models integrating clinical, genetic, and biomarker data aid in predicting long-term renal outcomes such as end-stage renal disease and cardiovascular complications. Future research directions emphasize multi-omics integration, personalized medicine approaches, and novel biomarker discovery to refine early intervention and improve patient outcomes. This comprehensive overview underscores the complex interplay of biological and clinical factors guiding AKI-to-CKD progression and highlights emerging translational opportunities to mitigate this trajectory.