ACUTE KIDNEY INJURY

Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body. AKI can also affect other organs such as the brain, heart, and lungs. Acute kidney injury is common in patients who are in the hospital, in intensive care units, and especially in older adults.

 

AKI can be caused by different factors:

Decreased blood flow. Some diseases and conditions can slow blood flow to your kidneys and cause AKI.

These diseases and conditions include:

  • Low blood pressure (called “hypotension”) or shock
  • Blood or fluid loss (such as bleeding, severe diarrhea)
  • Heart attack, heart failure, and other conditions leading to decreased heart function
  • Organ failure (e.g., heart, liver)
  • Overuse of pain medicines called “NSAIDs”, which are used to reduce swelling or relieve pain from headaches, colds, flu, and other ailments.  Examples include ibuprofen, ketoprofen, and naproxen.
  • Severe allergic reactions
  • Burns
  • Injury
  • Major surgery

Direct damage to the kidneys

Some disease and conditions can damage your kidneys and lead to AKI. Some examples include:

  • A type of severe, life-threatening infection called “sepsis”
  • A type of cancer called “multiple myeloma”
  • A rare condition that causes inflammation and scarring to your blood vessels, making them stiff, weak, and narrow (called “vasculitis”)
  • An allergic reaction to certain types of drugs (called “interstitial nephritis”)
  • A group of diseases (called “scleroderma”) that affect the connective tissue that supports your internal organs
  • Conditions that cause inflammation or damage to the kidney tubules, to the small blood vessels in the kidneys, or to the filtering units in the kidneys (such as “tubular necrosis,” “glomerulonephritis, “vasculitis” or “thrombotic microangiopathy”).

Blockage of the urinary tract

In some people, conditions or diseases can block the passage of urine out of the body and can lead to AKI. Blockage can be caused by:

  • Bladder, prostate, or cervical cancer
  • Enlarged prostate
  • Problems with the nervous system that affect the bladder and urination
  • Kidney stones
  • Blood clots in the urinary tract

Symptoms of AKI may include:

  • Little or no urine when you try to urinate.
  • Swelling, especially in your legs and feet.
  • Not feeling like eating.
  • Nausea and vomiting.
  • Feeling confused, anxious and restless, or sleepy.
  • Pain in the back just below the rib cage. This is called flank pain.

DIAGNOSIS

Depending on the cause of your acute kidney injury, your doctor will run different tests if he or she suspects that you may have AKI. It is important that AKI is diagnosed as soon as possible because it can lead to chronic kidney disease, or even kidney failure.  It may also lead to heart disease or death.

The following tests may be done:

  • Measuring urine output: Your healthcare provider will track how much urine you pass each day to help find the cause of your AKI.
  • Urine tests: Your healthcare provider will look at your urine (urinalysis) to find signs of kidney failure
  • Blood tests: Blood tests will help find levels of creatinine, urea nitrogen phosphorus and potassium should be done in addition to blood tests for protein in order to look at kidney function.
  • GFR: Your blood test will also help find your GFR (glomerular filtration rate) to estimate the decrease in kidney function.
  • Imaging tests: Imaging tests, such as ultrasound, may help your doctor see your kidneys and look for anything abnormal.
  • Kidney biopsy:  In some situations, your healthcare provider will do a procedure where a tiny piece of your kidney is removed with a special needle, and looked at under a microscope.

 

TREATMENT/MEDICATIONS

Treatment for AKI usually requires you to stay in a hospital. Most people with acute kidney injury are already in the hospital for another reason.  How long you will stay in the hospital depends on the cause of your AKI and how quickly your kidneys recover. In more serious cases, dialysis may be needed to help replace kidney function until your kidneys recover. The main goal of your healthcare provider is to treat what is causing your acute kidney injury. Your healthcare provider will work to treat all of your symptoms and complications until your kidneys recover.

After developing AKI, your chances are higher for other health problems (such as kidney disease, stroke, heart disease) or having AKI again in the future. The chances for developing kidney disease and kidney failure increase every time AKI occurs. To protect yourself, you should follow up with your healthcare provider to keep track of your kidney function and recovery. The best ways to lower your chances of having kidney damage and to save kidney function are to prevent acute kidney injury or to find and treat it as early as possible.

Your doctor will also work to prevent complications and allow your kidneys time to heal. Treatments that help prevent complications include:

Treatments to balance the amount of fluids in your blood. If your acute kidney failure is caused by a lack of fluids in your blood, your doctor may recommend intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have too much fluid, leading to swelling in your arms and legs. In these cases, your doctor may recommend medications (diuretics) to cause your body to expel extra fluids.

Medications to control blood potassium. If your kidneys aren’t properly filtering potassium from your blood, your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate, Kionex) to prevent the accumulation of high levels of potassium in your blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias) and muscle weakness.

Medications to restore blood calcium levels. If the levels of calcium in your blood drop too low, your doctor may recommend an infusion of calcium.

Dialysis to remove toxins from your blood. If toxins build up in your blood, you may need temporary hemodialysis — often referred to simply as dialysis — to help remove toxins and excess fluids from your body while your kidneys heal. Dialysis may also help remove excess potassium from your body. During dialysis, a machine pumps blood out of your body through an artificial kidney (dialyzer) that filters out waste. The blood is then returned to your body.

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