Acute kidney injury

Acute kidney injury
Other namesAcute renal failure (ARF), acute kidney failure (AKF)
Pathologic kidney specimen showing marked pallor of the cortex, contrasting to the darker areas of surviving medullary tissue. The patient died with acute kidney injury.
SpecialtyNephrology, Urology

Acute kidney injury (AKI), previously called acute renal failure (ARF),[1][2] is a sudden decrease in kidney function that develops within 7 days,[3] as shown by an increase in serum creatinine or a decrease in urine output, or both.[4]

Causes of AKI are classified as either prerenal (due to decreased blood flow to the kidney), intrinsic renal (due to damage to the kidney itself), or postrenal (due to blockage of urine flow).[5] Prerenal causes of AKI include sepsis, dehydration, excessive blood loss, cardiogenic shock, heart failure, cirrhosis, and certain medications like ACE inhibitors or NSAIDs.[5] Intrinsic renal causes of AKI include glomerulonephritis, lupus nephritis, acute tubular necrosis, certain antibiotics, and chemotherapeutic agents.[5] Postrenal causes of AKI include kidney stones, bladder cancer, neurogenic bladder, enlargement of the prostate, narrowing of the urethra, and certain medications like anticholinergics.[5]

The diagnosis of AKI is made based on a person's signs and symptoms, along with lab tests for serum creatinine and measurement of urine output. Other tests include urine microscopy and urine electrolytes. Renal ultrasound can be obtained when a postrenal cause is suspected. A kidney biopsy may be obtained when intrinsic renal AKI is suspected and the cause is unclear.[5]

AKI is seen in 10-15% of people admitted to the hospital and in more than 50% of people admitted to the intensive care unit (ICU).[4] AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, effects on other organ systems, and death. People who have experienced AKI are at increased risk of developing chronic kidney disease in the future.[4] Management includes treatment of the underlying cause and supportive care, such as renal replacement therapy.

  1. ^ Webb S, Dobb G (December 2007). "ARF, ATN or AKI? It's now acute kidney injury". Anaesthesia and Intensive Care. 35 (6): 843–44. doi:10.1177/0310057X0703500601. PMID 18084974.
  2. ^ Dan Longo; Anthony Fauci; Dennis Kasper; Stephen Hauser; J. Jameson; Joseph Loscalzo (July 21, 2011). Harrison's Principles of Internal Medicine, 18 edition. McGraw-Hill Professional.
  3. ^ Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007). "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury". Critical Care. 11 (2): R31. doi:10.1186/cc5713. PMC 2206446. PMID 17331245.
  4. ^ a b c Ronco C, Bellomo R, Kellum JA (23 November 2019). "Acute kidney injury". The Lancet. 394 (10212): 1949–64. doi:10.1016/S0140-6736(19)32563-2. PMID 31777389. S2CID 208230983.
  5. ^ a b c d e Mercado MG, Smith DK, Guard EL (1 December 2019). "Acute Kidney Injury: Diagnosis and Management". American Family Physician. 100 (11): 687–694. PMID 31790176.