Kidney Injury, Acute
Basics
Description
Description
- “Renal failure” is an outdated term
- Acute kidney injury (AKI) is newly defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification as:
- Serum creatinine ≥0.3 mg/dL within 48 hr; or
- Serum creatinine increase to ≥1.5 times baseline, occurring within prior 7 d; or
- Urine volume <0.5 mL/kg/hr for 6 hr
- Serum creatinine or urine volume maximum changes determine AKI stage
- KDIGO staging:
- Stage 1: Cr ≥0.3 mg/dL increase or 1.5–1.9 × baseline or UO <0.5 mg/kg/hr × 6 hr
- Stage 2: Cr 2–2.9 × baseline or UO 0.5 mg/kg/hr × 12 hr
- Stage 3: Cr ≥3 × baseline or ≥4 mg/dL or UO <0.3 mg/kg/hr × 24 hr or anuria ≥12 hr or the initiation of renal replacement therapy
- AKI consequences include:
- Waste product accumulation
- Electrolyte disturbances
- Fluid accumulation
- Reduced immunity
- Other organ dysfunction
- AKI leads to increased morbidity and mortality
- AKI biomarkers will become increasingly important for early diagnosis, differential diagnosis, and prognosis
Etiology
Etiology
- Prerenal AKI:
- Caused by renal hypoperfusion
- Renal tissue remains normal unless severe/prolonged hypoperfusion
- Intrarenal AKI:
- Caused by renal parenchymal diseases
- Iatrogenic AKI, causes include:
- Aminoglycoside antibiotics
- NSAIDs
- ACE inhibitors
- Angiotensin receptor blockers
- IV contrast may be a risk in patients with significant preexisting disease
- Postrenal AKI:
- Due to urinary tract obstruction (e.g., prostatic hypertrophy, prostatitis)
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Citation
Schaider, Jeffrey J., et al., editors. "Kidney Injury, Acute." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307710/4/Kidney_Injury_Acute.
Kidney Injury, Acute. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307710/4/Kidney_Injury_Acute. Accessed October 11, 2024.
Kidney Injury, Acute. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307710/4/Kidney_Injury_Acute
Kidney Injury, Acute [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 11]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307710/4/Kidney_Injury_Acute.
* Article titles in AMA citation format should be in sentence-case
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T1 - Kidney Injury, Acute
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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