Acute kidney injury in interstitial nephritis Purpose of review The purpose of this review is to describe the most common causes of acute interstitial nephritis (AIN), the diagnostic work-up and the therapeutic management. Recent findings Several case series and registries have found an increasing incidence of AIN, especially among older patients. Drug-induced AIN still represents the most common cause. Early withdrawal of the culprit drug together with corticosteroid therapy remain the mainstay of treatment, although recent studies have shown that prolonged treatment beyond 8 weeks does not further improve kidney function recovery. Summary AIN is a common cause of acute kidney injury, and therefore, physicians should suspect this entity especially in patients exposed to multiple medications. While immune-allergic reaction to numerous drugs is the most common cause of AIN, other underlying systemic diseases may also be involved, and therefore, every patient should undergo a complete diagnostic evaluation. Kidney biopsy provides the definitive diagnosis of AIN, and certain histologic features may help to identify the underlying condition. In drug-induced AIN, an early discontinuation of the culprit drug is the mainstay of therapy, and unless a rapid recovery of kidney function is observed, a course of glucocorticoid therapy should be initiated. Correspondence to Manuel Praga, Department of Nephrology, Hospital 12 de Octubre, Avda de Córdoba s/n, 28041 Madrid, Spain. Tel: +34 913908208; e-mail: mpragat@senefro.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Trauma-associated acute kidney injury Purpose of review A summary of recent research into the epidemiology, cause, management and outcomes of trauma-associated acute kidney injury (AKI). There is an increasing focus on subtypes of AKI to better target clinical management and future research. Recent findings AKI associated with trauma occurs in 20–24% of patients admitted to ICU. On the basis of creatinine and/or urine output, AKI occurs in the first few days of traumatic illness. Although various associations have been identified, shock and high-volume blood transfusion are the most consistent risks for development of trauma-associated AKI. Short-term outcomes appear worse for patients with AKI, but extent of longer term kidney function recovery remains unknown. Recent research in the general critical care population is beginning to better inform AKI management; however, currently, preventive and supportive strategies remain the mainstay of AKI management after trauma. Summary Well-designed, prospective research is required to better understand the phenotype, pathophysiology and recovery trajectory of trauma-associated AKI. Only then can potentially unique therapeutic targets be developed for this common subtype of AKI. Correspondence to John R. Prowle, Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK. E-mail: j.prowle@qmul.ac.uk Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Emergent airway management of the critically ill patient: current opinion in critical care Purpose of review To describe techniques to facilitate safe intubation in critically ill patients. Recent findings Despite advances in the treatment of critically ill patients, endotracheal intubation remains a high-risk procedure associated with complications that can lead to appreciable morbidity and mortality. In addition to the usual anatomical factors that can predict a difficult intubation, incorporating pathophysiological considerations and crisis resource management may enhance safety and mitigate risk. Enhancing preoxygenation with high-flow oxygen or noninvasive ventilation, the early use of intravenous fluids and/or vasopressors to prevent hypotension and videolaryngoscopy for first pass success are all promising additions to airway management. Facilitating intubation by either sedation with paralysis or allowing patients to continue to breathe spontaneously are reasonable options for airway management. These approaches have potential advantages and disadvantages. Summary Recognizing the unique challenges of endotracheal intubation in critically ill patients is paramount in limiting further deterioration during this high-risk procedure. A safe approach to intubation focuses on recognizing risk factors that predict challenges in achieving an optimal view of the glottis, maintaining optimal oxygenation, and minimizing the risks and benefits of sedation/induction strategies that are meant to facilitate intubation and avoid clinical deterioration. Correspondence to Michael E. Detsky, MD, Department of Critical Care, Mount Sinai Hospital, 600 University Avenue, Office 18-232, Toronto, ON, Canada M5G 1X5. E-mail: Michael.detsky@sinaihealthsystem.ca Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Drug-induced acute kidney injury: diverse mechanisms of tubular injury Purpose of review Medications are a relatively common cause of acute kidney injury (AKI), especially in hospitalized patients who are exposed to numerous agents. Drug-related acute tubular/tubulointerstitial injury is the most common cause of AKI associated with these agents. Toxic effects of drugs and their renal handling often lead to various forms of AKI. Recent findings The inherent nephrotoxicity of drugs and their transport and metabolism by the kidneys play an important role in the occurrence of acute tubular injury. Apical transport of the aminoglycosides by endocytosis and apical pinocytosis of filtered hydroxyethyl starch into cells lead to acute tubular dysfunction. Transport of tenofovir and cisplatin by organic anion and cation transporters in the basolateral surface of the proximal tubule, respectively, are associated with intracellular drug accumulation and injury. Intratubular deposition of drug crystals with associated AKI occurs with several drugs, in particular the anticancer agent methotrexate. A potentially new mechanism of drug-induced AKI was described with vancomycin – acute vancomycin-related cast nephropathy. Immune-mediated acute tubulointerstitial injury is another cause of drug-induced AKI, as seen with immune checkpoint inhibitors. Summary Drugs lead to AKI through mechanisms that involve their inherent toxicity as well as their transport and handling by the kidneys. Correspondence to Mark A. Perazella, Section of Nephrology, Department of Medicine, Yale University, BB 114, 330 Cedar Street, New Haven, CT 06410, USA. E-mail: mark.perazella@yale.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.