Acute Kidney Injury

Acute Kidney Injury (AKI) is a sudden and usually reversable decrease in the glomerular filtration rate (GFR) ocurring in a period of hour or days.

Other Names

• Acute Renal Failure

Types

• Pre-renal
• Renal
• Post-renal

Signs and Symptoms

Symptoms of decrease kidney function develop as a result of the accumulation of toxins in the blood that are normally removed by the kidney. Patients describe nausea, decreased appetite and trouble sleeping. Symptoms can also develop from the accumulation of fluid in the body, causing shortness of breath and swelling of the hands, feet, and legs. Depending on the cause and severity of the kidney injury, urine production may decrease or abruptly stop.

A physical exam is done to evaluate for signs of fluid retention demonstrated by hypertension, swelling of the extremities or abdomen, and fluid accumulation in the lungs. The accumulation of toxins in the body can cause "asterixis", or a flapping of the hands when the patient holds their arms out like a triffic officer signally to "stop" traffic.

Causes

Pre-renal causes

Severe fluid loss/dehydration: eg gastroenteritis from vibrio cholerae,salmonella enteritis, shigellosis. Extensive burns injury, Massive blood loss:eg obstetric haemorrhages APH/PPH Blood loss from trauma: RTAs large vessel injuries Haemolytic syndromes: Haemoglobinopathies, HUS

Renal causes

Acute post streptococcal glomerulonephritis Nephrotoxins:large doses of aminoglycosides, herbal remedies,contrast media Acute pyelonephritis

Post-renal causes

Surgical errors eg ligation of ureters during surgery

Diagnosis

Clinical signs and symptoms, laboratory results showing elevated urea and creatinine, hyperkalemia, acidosis, renal ultrasound

Treatment

Resurcitate patient, treat underlying cause,haemodialysis or peritoneal dialysis, while kidney is recovering. Full recovery is expected within 4 to 6 weeks