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Acute Kidney Injury

Jason Kurland, MD Reviewed 06/2019
 


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 for...

DIAGNOSIS

HISTORY

  • Ascertain changes in PO intake, urine output, and body weight.

  • Thorough medication history

  • Prerenal: thirst, orthostatic symptoms

  • Intrarenal: nephrotoxic medications, radiocontrast mater...

TREATMENT

GENERAL MEASURES

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

  • Strictly monitor intake/output and daily weight.

  • 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 (1)

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

REFERENCES

1
International Society of Nephrology. Summary of recommendation statements. Kidney Int Suppl (2011).  2012;2(1):8–12. [View Abstract on OvidMedline]
2
Wang HE, Muntner P, Chertow GM, et ...

ADDITIONAL READING

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

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

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

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