Acute Kidney Injury

acute kidney injury

Acute Kidney Injury

When a patient encounters a sudden loss of kidney functions with an exponential increase in their kidney degradation, they are suffering from Acute kidney injury. In this condition, the kidney loses all its functions in the time period of few days. The functions of the kidney encompass the following:

  • Filtration of blood
  • Removal of waste
  • Balances of fluids
  • Regulation of electrolytes
  • Maintenance of PH levels

What happens in acute kidney injury?

Due to the kidney function loss in acute kidney injury body undergoes certain complications such as:

  • Hypervolemia: Fluid overload
  • Creatinine accumulation
  • Urea accumulation
  • Constrains in the removal of potassium through waste
  • Reduction of calcium in the blood
  • Acid buildup in the blood
  • Anemia

Usually, acute kidney injury is diagnosed when both the kidneys have lost their functions up to 50%

What causes acute kidney injury?

By a surprising fact, though acute kidney injury is determined by rapidly deteriorating intrinsic functionality of the kidney, it is mostly caused by an underlying condition that lies outside the kidneys. This leads to the classification of causes of kidneys into three categories as these causes are diverse:

  • Prerenal: In this category of causes, the blood flow to the kidneys is inadequate. This can happen due to the following:
    • Extracellular fluid volume depletion due to vomiting and diarrhea
    • Decreased cardiac output due to myocardial infarction, pericardial tamponade, or constrictive pericarditis
    • Drug intake (such as NSAIDs, E inhibitors, Angiotensin receptor blockers)
    • Artery obstruction

In this type of acute kidney injury, if the patients do not have a history of kidney failure, kidney functions are usually recovered by resolving the condition causing it

  • Renal: If the causes contributing to acute kidney injury are embedded in the kidney itself, the causes are said to be renal. The most affected parts of the kidney in this type are glomeruli, renal tubules, and interstitium. Generally, these organs in acute kidney injury get necrosis or inflamed. The inflammation or necrosis of these organs is caused by:
    • Glomerulonephritis
    • Drugs
    • Myeloma
    • Sarcoid
    • Renal vein thrombosis
    • Thrombotic microangiopathies
  • Post renal: In this type of acute kidney injury constraints occur in the storage or passage at some specific parts of the urinary system. These constrictions can occur in renal tubules, ureters, and urethra. These obstructions are generally caused by stones or enlarged prostate.

In some cases, one category of causes can lead to another. This means sometimes prerenal causes can lead to renal causes which in turn can cause post-renal causes. This can lead to the exponential degeneration of kidney functions

What are the symptoms of the acute renal injury?

The symptoms of acute kidney injury can range from mild to severe depending upon the time for which the cause of AKI works upon the kidney. Some of these symptoms re:

  • Edema
  • Acidosis
  • Hyperkalemia
  • Nausea
  • Diarrhea
  • Vomiting
  • Confusion
  • Coma
  • Breathlessness

Diagnosis and Clinical stages of acute kidney injury

Diagnosis of acute kidney injury is done by evaluating the creatinine levels and by monitoring the urine. These evaluations are done by following tests:

  • BUN
  • Serum electrolytes test
  • Urinary sediment test
  • Urinalysis
  • Ultrasound

There are three stages of acute kidney injury based on the creatinine level and urine output

Stage 1: The first stage comes when the creatinine level increases 1.5 to 1.9 times the baseline creatinine and the urine output is reduced to 0.5mL/Kg/hr.

Stage 2: in the second stage the creatinine level rises to 2.0 to 2.9 times the baseline creatinine and the urine output stays 0.5mL/Kg/hr. for 12 hours.

Stage 3: the last stage of AKI occurs when the creatinine level rises to 3 times more than the baseline and the urine output is lower to 0.3mL/Kg/hr. and this persists for 24 hours. At this stage of AKI, the patient usually needs to be put on dialysis.

Steps that are taken at the hospitals to treat AKI patients

  • Separate the patients on the basis of their stages
  • Stop certain categories of medications such as NSIADs, nephrotoxins, etc.
  • Hydrate the patients
  • Monitoring induced drug levels

The treatment of AKI aims to resolve the underlying cause of the condition but if the patient has reached the third stage, they are first put on dialysis.

Conclusion

Acute kidney failure can be treated. By admitting into a management Centre/ hospital that provides the treatment for AKI in order to treat the actual cause of this disease, you can recover your kidneys completely. It is important to know that you become more susceptible to other health conditions after the treatment of AKI. It is your responsibility to follow every bit of instruction your well-experienced doctor provides you in order to keep up a healthy life.

At Alfa kidney care, we aim at diagnosing with complete precision to provide the treatment for AKI as soon as possible

To know more, Contact at: Dr. Ravi Bhadania