Acute Kidney Injury

Jason Kurland, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

Abrupt loss of kidney function, defined as a rise in serum creatinine (SCr) of ≥0.3 mg/dL within 48 hours; a 50% increase in SCr within 7 days, or urine output of <0.5 mL/kg/hr fo...

DIAGNOSIS

HISTORY

  • General: PO intake, urine output, body weight, medication use

  • Prerenal: thirst, orthostatic symptoms

  • Intrarenal: nephrotoxic medications, radiocontrast material, other toxins

    • Fever, ar...

TREATMENT

GENERAL MEASURES

Identify and correct prerenal and postrenal causes. 
  • Stop nephrotoxic drugs and renally dose others.

  • Strict intake/output and daily weight recordings

  • Optimize cardiac output to ...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Nephrology follow-up if persistent renal impairment and/or proteinuria 

DIET

  • Total caloric intake of 20 to 30 kcal/kg/day to avoid catabolism (1)

  • Restrict Na+ to 2 g...

REFERENCES

1 International Society of Nephrology. Summary of recommendation statements. Kidney Int Suppl.  2012;2(1):8–12.  [View Abstract]
2 Wang HE, Muntner P, Chertow GM, et al. Acute kidney...

ADDITIONAL READING

  • ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcystei...

SEE ALSO

  • Glomerulonephritis, Acute; Hepatorenal Syndrome; Hyperkalemia; Prostatic Hyperplasia, Benign (BPH); Chronic Kidney Disease; Reye Syndrome; Rhabdomyolysis; Sepsis

  • Algorithm: Anuria or Oliguria

CODES

ICD10

  • N17.9 Acute kidney failure, unspecified

  • N17.0 Acute kidney failure with tubular necrosis

  • N00.9 Acute nephritic syndrome with unsp morphologic changes

  • N10 Acute tubulo-interstitial nephritis

  • S37...

CLINICAL PEARLS

  • Three categories of AKI:

    • Prerenal: decreased renal perfusion (often from hypovolemia) leading to a decrease in GFR; reversible if perfusion is restored

    • Intrarenal: intrinsic kidney dam...

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