Acute Kidney Injury

Acute Kidney Injury


By Dr. D.K. Agarwal, Nephrology

What is Acute Kidney Injury?

It’s a condition in which the kidneys can’t filter waste from the blood i.e. a decrease in renal function – rapid rise in serum creatinine or decrease in urine output. Clearance of waste product is dependent on the glomerular filtration rate (GFR).

Regardless of the cause of acute kidney injury (AKI), reductions in RBF represent a common pathologic pathway for decreasing GFR.

Acute Kidney Injury can be divided into pre-renal, renal or post-renal etiology:

  1. Pre-renal: Defined by conditions with normal tubular and glomerular function. GFR is depressed by compromised renal perfusion.
  2. Renal: Diseases that affect the kidney itself, predominantly affecting the renal glomeruli or the renal tubules, which is associated with release of renal afferent vasoconstrictors. Ischemic renal injury is the most common cause of intrinsic renal failure
  3. Post-renal: Initially causes an increase in tubular pressure, decreasing the filtration driving force. This pressure gradient soon equalizes, and maintenance of a depressed GFR is then dependent on renal efferent vasoconstriction.

Causes of Acute Kidney Injury:

It often results from inadequate renal perfusion on account of severe trauma, illness or surgery, sometimes caused by a rapidly progressive, intrinsic renal disease.

Symptoms of AKI:

  1. Anorexia: Eating disorder causing people to obsess about weight and what they eat.
  2. Nausea: Uneasiness of the stomach that often comes before vomiting.
  3. Vomiting: Frequent Vomiting.
  4. Weakness: Feeling of Weakness.
  5. Confusion: Uncertainty about what is happening, what is intended or required of oneself.

As a result seizures and coma may occur if left untreated for long.

How is it Diagnosed?

The condition can be diagnosed by getting the following examination done. However, always consult a physician before going ahead.

  1. Serum creatinine,
  2. Urinary sediment,
  3. Urinary diagnostic indices,
  4. Post void residual bladder volume if post renal cause suspected.

Treatment of Acute Kidney Injury:

  1. Immediate treatment of pulmonary edema and hyperkalemia,
  2. Dialysis as needed to control hyperkalemia, pulmonaryedema, metabolic acidosis, and uremic symptoms,
  3. Adjustment of drug regimen,
  4. Usually restriction of water, sodium, phosphate, and potassium intake, but provision of adequate protein,
  5. Possibly phosphate binders and sodium polystyrene sulfonate.

How can it be prevented?

Acute Kidney Injury can often be prevented by the following measures:

  1. Maintaining normal fluid balance,
  2. Blood volume,
  3. Blood Pressure in patients with trauma.

    If you wish to discuss about any specific problem, you can consult a nephrologist and ask a free question.