Acute Kidney Injury
Summary
This is a summary of Acute Kidney Injury from a primary level of care perspective.
Basics
Acute kidney injury refers to a sudden or abrupt decrease in kidney function. This may involve both structural damage or loss of function. The decline in renal function usually occurs within hours. The old terminology for acute kidney injury was acute renal failure.
Etiology
- Pre-renal AKI
- Hypovolemia
- Impaired cardiac function
- Systemic vasodilation
- Increased vascular resistance
- Intrinsic AKI
- Tubular damage
- Ischaemic
- Nephrotoxic
- Glomerular damage
- Interstitial damage
- Vascular damage
- Tubular damage
- Post-renal AKI
- Extra-renal obstruction
- Intra-renal obstruction
Classification
Clinical
Usually depends on the clinical setting. The common presentation includes symptoms and signs of fluid overload (e.g., pulmonary edema), decreased or no urine output, abnormal electrolytes, and creatinine.
Management
General
- If respiratory distress, provide the patient with oxygen and manage in a semi-fowlers position
- If there is fluid overload: stop all IV fluids.
- If the patient is dehydrated or in shock: treat the shock.
- Stop and avoid all nephrotoxic medicines: NSAIDS, Aminoglycosides.
Medical
- If fluid overload or respiratory distress
- Furosemide 80mg IV bolus. Do not put up a drip with fluids and do not give a fluid infusion.
- If the patient has hypertension with BP > 150/100:
- Furosemide 40-80mg AND Amlodipine 5mg PO as a prereferral dose.
Referral
- All cases should be referred from a primary level of care to a higher level of care.
References and Further Reading
1. The National Department of Health, South Africa: Essential Drugs
Programme. Primary Healthcare Standard Treatment Guideline and
Essential Medicine List. 7th ed. South African National Department of Health;
2020.
2. Figure 1 and Figure 2: Levin, A. and Stevens, P.E. (2014) “Summary of KDIGO 2012 CKD guideline: Behind the scenes, need for guidance, and a framework for moving forward,” Kidney International, 85(1), pp. 49–61. Available at: https://doi.org/10.1038/ki.2013.444.
2. Figure 1 and Figure 2: Levin, A. and Stevens, P.E. (2014) “Summary of KDIGO 2012 CKD guideline: Behind the scenes, need for guidance, and a framework for moving forward,” Kidney International, 85(1), pp. 49–61. Available at: https://doi.org/10.1038/ki.2013.444.
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