Acute Kidney Injury
Introduction
Acute kidney injury (AKI) refers to the abrupt decrease in kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes.
- Increase in serum creatinine by ≥0.3 mg/dL (≥26.5 micromol/L) within 48 hours.
- Increase in serum creatinine of ≥50% from baseline, which is known or presumed to have occurred within the prior 7 days, or
- Fall in urine output to <0.5 ml/kg/hour for >6 consecutive hours in adults and >8 hours in children.
Categories
AKI can be divided into 3 categories based on their different aetiology, pathophysiology and management.
- Prerenal injury is a functional response to renal hypoperfusion and is not associated with a structural injury to the kidney itself.
- Postrenal AKI results from obstruction of the urinary collecting system. Obstruction may occur at the level of the bladder, urethra, ureters or renal pelvis. This must occur in both kidneys in order to cause AKI.
- Intrinsic AKI occurs due to an injury to the structural component of the kidney.
General Treatment
Hydration.
Discontinuing any nephrotoxic agents.
Treatment of underlying conditions contributing to the injury.
Renal replacement therapy (dialysis) is used when correction of electrolyte imbalances is required, particularly with increased potassium, fluid overload, and when removal of uremic or other toxins is necessary.
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