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Acute Kidney Injury

Michelle Nelson, MD and Arturas Klugas, MD, FAAFP Reviewed 04/2024
 


BASICS

DESCRIPTION

An abrupt loss of kidney function, acute kidney injury (AKI) defined as (1): 
  • Increase in serum creatinine (SCr) of ≥0.3 mg/dL within 48 hours

  • ≥50% increase in baseline SCr within 7 d...

DIAGNOSIS

Acute kidney injury (AKI) is usually asymptomatic until the patient has experienced severe loss of function. Oliguria can be present, but it is neither specific nor sensitive. 

HISTORY

  • Thorou...

TREATMENT

Fluid resuscitation is the mainstay of treatment of AKI, both in prerenal and in some forms of intrinsic kidney injury. In severe cases of kidney injury, renal replacement therapy (RRT) may ...

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  (1)

  • Restrict Na+ to 2 g/day (unless hypovo...

REFERENCES

1
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Onter. 2012;(Suppl2):1–138.
2
Gonsales SR,...

SEE ALSO

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

  • Algorithm...

CODES

ICD10

  • N17.0 Acute kidney failure with tubular necrosis

  • N17.1 Acute kidney failure with acute cortical necrosis

  • N17.8 Other acute kidney failure

  • N17.9 Acute kidney failure, unspecified

  • N17.2 Acute kid...

CLINICAL PEARLS

  • Three categories of AKI:

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

    • Intrarenal: intrinsic kidney damage; ATN most common due to...

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