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Acute Kidney Injury (AKI)
Sudden decrease in kidney function characterized by an increase in serum creatinine or decrease in urine output, or both.
Classification:
Stage | Serum Creatinine Criteria | Urine Output Criteria |
---|---|---|
Stage 1 | Increase by 1.5-1.9 times baseline or ≥0.3 mg/dL increase | <0.5 mL/kg/h for 6-12 hours |
Stage 2 | Increase by 2.0-2.9 times baseline | <0.5 mL/kg/h for ≥12 hours |
Stage 3 | Increase by 3.0 times baseline or ≥4.0 mg/dL increase or initiation of renal replacement therapy | <0.3 mL/kg/h for ≥24 hours or anuria for ≥12 hours |
Etiology:
Prerenal Causes | Intrarenal Causes | Postrenal Causes |
---|---|---|
Hypovolemia | Acute Tubular Necrosis (ATN) | Urinary tract obstruction |
Hypotension | Glomerulonephritis | Prostatic hypertrophy |
Heart failure | Interstitial nephritis | Urethral stricture |
Renal artery stenosis | Acute interstitial nephritis | Bladder outlet obstruction |
Clinical Features:
Investigations:
Test | Purpose |
---|---|
Serum Creatinine | Assess kidney function |
Blood Urea Nitrogen (BUN) | Assess kidney function |
Urinalysis | Identify presence of blood, protein, casts |
Renal Ultrasound | Evaluate kidney size, presence of obstruction |
Urine Output Measurement | Monitor urine output |
Management:
General Measures | Specific Treatments |
---|---|
Fluid resuscitation | Treat underlying cause (e.g., volume depletion) |
Electrolyte management | Discontinue nephrotoxic medications (if applicable) |
Avoid nephrotoxic medications | Dialysis (if indicated) |
Complications:
Prognosis:
Key Points to Remember: