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Acute Kidney Injury

Pratha Muthiah, MD, MPH and Jason Chao, MD, MS Reviewed 06/2020
 


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

AKI is usually asymptomatic until the patient has experienced extreme loss of function. Oliguria can be present, but it is neither specific nor sensitive (3). 

HISTORY

  • Ascertain changes in ora...

TREATMENT

Fluid resuscitation is the mainstay of treatment of AKI, both in prerenal and intrinsic kidney injury. In severe cases of kidney injury, dialysis may be required, especially in cases where t...

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 GMet al...

ADDITIONAL READING

  • Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int.  2012;81(5):442–448. [View Abstract on O...

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 ...

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