How To Treat Acute Kidney Injury

How Is Aki Diagnosed

When a patient shows sudden high levels of creatinine in the blood, it is likely that the patient is experiencing acute kidney injury. Doctors will use clinical context to rule out other similar conditions, such as chronic kidney disease. Usually, if the patient has been showing abnormal creatinine levels for a while and has co-occurring conditions such as hypertension and diabetes, they are more likely have chronic kidney disease.

Once AKI is diagnosed, doctors will try to find the underlying cause in order to treat it. Sometimes, the underlying cause is easily identifiable because it correlates with another major condition that may have led to blood loss or infection .

If your doctor suspects that you might have acute kidney injury, he or she might perform the following tests:

What Is Acute Kidney Failure

Acute kidney failure is when your kidneys stop working suddenly. Doctors sometimes call it acute renal failure. It can happen over just a few hours or days.

Acute kidney failure isnât always permanent. If you get treatment right away — and if you donât have other serious health problems — your kidneys can go back to working normally.

The main job of your kidneys is to filter waste out of your blood. They also remove extra fluid from your blood and control blood pressure. Kidneys help make red blood cells. They regulate electrolytes and activate vitamin D, too.

Kidneys donât work well when theyâre damaged. This could happen because of another health condition, like diabetes. A decrease in kidney function that happens over a longer period of time is called chronic kidney disease .

Imaging Tests To Check For Blockages In The Urinary Tract

These tests might include:

• abdominal x-ray: invisible electromagnetic energy beams produce images of internal tissues, bones and organs onto film
• renal ultrasound : a painless, non-invasive test in which a transducer is passed over your childs kidneys, producing sound waves that bounce off the kidney and transmit a picture on a video screen. The test can detect a mass, kidney stone, cyst or other obstruction or abnormality. Read more about ultrasounds.
• nuclear medicine study: non-invasive, painless tests that can reveal important information about your child’s health. Nuclear medicine uses short-lived radiopharmaceuticals and specialized cameras to create images of the human body.

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Talk To Your Doctor About Your Current Medications

Talk to your doctor immediately about any medications, vitamins, or supplements youre taking. When your kidneys are injured, many medications require close adjustment because theyre cleared through your kidneys and could cause additional harm. Ask questions and make sure you understand any new medication instructions.

Enhancing Healthcare Team Outcomes

Acute kidney injury does have significant morbidity and mortality if it is left untreated. The aim today is to try and prevent the condition in the first place by employing an interprofessional team approach. All healthcare workers must be aware of the condition, its causes, and potential complications.

At the first signs of creatinine elevation, the pharmacist should ensure that the patient is on no nephrotoxic medications. The patient should be educated that the regular consumption of NSAIDs is harmful to the kidney. The patient should be instructed to remain compliant with his blood pressure medications since uncontrolled hypertension can worsen kidney injury.

The nurse practitioner should ensure that the patient is well hydrated and is producing adequate urine before any contrast study. For those who develop acute kidney injury, the nurse should educate the patient to avoid agents such as NSAIDs to prevent the worsening of the renal injury. Plus, close follow-up with a nephrologist is highly recommended. Finally, the patient should have a dietary consult because salt and fluid restriction is vital when managing acute kidney injury. Similarly, the patient should avoid a high potassium diet when there is renal dysfunction. Because acute kidney injury induces a catabolic state, the patient should be encouraged to eat at least 1800 calories per day.

Outcomes

• Advanced age

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What Is Unique About The Way Yale Medicine Treats Aki

Yale Medicine is at the forefront of detecting acute kidney injury before it happens. Our researchers are looking for reliable biomarkers for the condition and testing real-time electronic alerts for kidney damage. The goal is to determine whos at risk beforehand and prevent it from becoming a problem. Were taking an active role in acute kidney injury, Dr. Wilson says. We believe that by intervening early right when the kidney function starts to decrease that we can mitigate the injury, which could improve outcomes in the long run for patients.

Acute Kidney Failure Symptoms

You may not have any symptoms of acute kidney failure. Your doctor may discover you have this condition while doing lab tests for another reason.

If you do have symptoms, theyâll depend on how bad your loss of kidney function is, how quickly you lose kidney function, and the reasons for your kidney failure. Symptoms may include:

• Peeing less than normal

• You have heart failure or high blood pressure.
• You have chronic kidney or liver disease.

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Acute Kidney Injury: Causes Symptoms And Treatment

Acute kidney injury is a sudden episode of acute kidney failure or kidney damage that takes place within a few hours or days. As a result, there is a buildup of waste in the bloodstream which impairs the kidneys ability to maintain the proper balance of fluids in the body. As a result, other organs in the body can become affected, including the brain, heart, and lungs.

Acute kidney injury is most commonly seen among people who have been hospitalized, particularly in those who need intensive care.

Box 1 Selected Causes Of Aki

Pre-renal causes, impaired renal perfusion

Cardiorenal syndrome, including heart failure with reduced ejection fraction, right-sided heart failure and venous congestion

Shock, including haemorrhagic shock, hypovolaemic shock and septic shock

Abdominal compartment syndrome

Thrombotic microangiopathies, cholesterol embolism, anti-glomerular basement membrane disease and immune complexes and anti-neutrophilic cytoplasmic autoantibody vasculitis

Sickle cell anaemia and sepsis

Systemic infections and sepsis, pyelonephritis, drug-related or heavy metal-related tubule necrosis, crystal-induced nephropathy , myoglobin , contrast media, light chains and metabolites

Acute cellular rejection, acute interstitial nephritis, immune checkpoint inhibitor-related and cytokine release syndrome upon chimeric antigen receptor T cell therapy

Post-renal causes, urinary tract obstruction

Bilateral ureteral obstruction, bladder dysfunction and urethral obstruction

AKI, acute kidney injury.

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Causes Of Acute Renal Failure And Their Treatments

• Acute Renal Failure: Stages, Symptoms, Treatment, and More

Treatment for acute renal failure , or acute kidney failure, involves various medications and procedures depending on the cause. With this condition, your kidneys are damaged and unable to filter waste from your blood.

Your treatment may include vasopressor drugs to help raise blood pressure, intravenous fluids to aid in rehydration, and diuretics to increase urine output. Hemodialysis may be used to help filter the blood while the kidneys are healing.

The course of treatment is directed by the underlying cause, which is broadly classified into one of three groups:

• Prerenal ARF, in which the blood flow to the kidneys is impeded
• Intrinsic ARF, in which the kidneys themselves are impaired
• Postrenal ARF, in which the flow of urine out of the body is obstructed

This article discusses the different causes of acute renal failure and the treatments available for each.

Acute Kidney Injury Treatment Options

Treatment for acute kidney injury often involves treating the underlying cause. Another important aspect of treating acute kidney injury is to prevent fluid and waste buildup while your kidneys are healing.

In order to properly treat acute kidney injury, you will be referred to a kidney specialist nephrologist who will evaluate your condition and make recommendations for your treatment.

Diet changes are also necessary to treat AKI. A diet high in carbohydrates and low in protein, salt, and potassium is usually recommended. You may also be advised to go on antibiotics to fight off any infection along with diuretics to remove fluid.

If kidney damage is severe or waste buildup is in excess, you may be recommended for dialysis to help filter out your blood.

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Other Methods Of Measuring Kidney Function

To date, no validated method exists for continuously measuring GFR in critically ill patients. However, one study published in 1994 demonstrated that such monitoring is feasible,. Ongoing attempts to overcome practical obstacles may eventually implement this method in clinical practice. Rapid kidney function assessment can be achieved by collecting urine and a repeated blood sample to determine creatinine clearance, which can also be reliably performed in the case of oliguria,. Creatinine clearance has been shown to diagnose impairment of kidney function earlier than plasma creatinine rise.

Blood Urine And Other Tests To Determine How Well Your Childs Kidneys Are Functioning

There are two main ways to measure your childs kidney functioning: creatinine level and glomerular filtration rate .

• Creatinine is a waste product that the body makes daily in proportion to a persons muscle mass. It can leave the body only through the kidneys, and levels can be checked through a simple blood test. If your child has AKI, we will see her creatinine level rise quickly.
• GFR is a measurement of how efficiently your kidneys are able to filter your blood. Read more about the GFR testat Childrens Hospital Boston.

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Acute Kidney Injury And Failure Treatment

At the UPMC Kidney Disease Center, we’ll work with you to find a reversible cause of your acute kidney injury. Then we’ll design a treatment plan based on that cause.

If diagnosed early, acute kidney injury treatments include:

• Diet changes. You might need to make some diet changes to reduce strain on your injured kidneys or to support healing.
• Medicine. Depending on the cause of your injury, some drugs may help support your kidneys while they heal. You’ll also need to change any medications that may be harming your kidneys.
• Short-term dialysis. In some cases, your kidneys may temporarily stop performing their vital functions. Dialysis can take over for your kidneys for a short time, cleaning waste from your blood and controlling your blood pressure.

For cases where injury has led to kidney failure, we’ll help you decide the best treatment for you such as:

No matter the cause of your kidney injury, you have hope at the UPMC Kidney Disease Center. We’re here to help you return to a healthy life.

Acute Kidney Injury Risks And Complications

Factors that may increase your risk for acute kidney injury include:

• Any serious condition that causes a hospital stay.
• Kidney disease of any kind.
• Being over the age of 60.
• Certain cancers.

Complications linked to acute kidney injury include:

• Permanent kidney damage.
• Fluid buildup in the lungs.
• More life-threatening electrolyte effects, such as high potassium levels.
• Further side effects from drugs that your kidney processes.

Recovery from kidney injury depends on what caused the damage and your overall health.

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What Are The Symptoms Of Acute Kidney Injury

The most common symptoms are:

• passing less urine than usual
• very concentrated urine, or urine looking yellow/brown/red in colour
• loss of appetite
• feeling sick or vomiting
• feeling tired and short of breath
• feeling confused, anxious and restless, or sleepy
• swelling of your legs or other body parts
• pain in your abdomen or lower back.

Sometimes AKI can occur without any symptoms and can only be picked up by a blood test.

Supporting Your Childs Kidneys As They Recover

• close monitoring of important electrolytes such as potassium, sodium and calcium, which may also be replaced through an IV
• medication to control blood pressure or prevent infections
• specific diet requirements to limit the amount of toxins in your childs bloodstream as the kidneys heal

If your childs AKI is quite severe, her doctors may recommend dialysis, a procedure that filters and rebalances your childs blood so that her kidneys can rest and heal. Learn more about dialysis.

Typically, your child will be weaned off dialysis as the kidneys repair themselves. In rare cases, after three months on dialysis, the kidneys still might not have regained function. This may indicate that the kidneys are unable to repair themselves enough to work properly, and your childs doctor may recommend that she continue dialysis or begin to be evaluated for a kidney transplant.

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Diagnosing Acute Kidney Injury

If you do present signs and symptoms of acute kidney injury, your doctor will need to run tests in order to properly diagnose the condition. Diagnostic tests for acute kidney injury include urine output measurements, urine tests, blood tests, imaging tests like ultrasound or CT scan, and a biopsy.

These tests help determine if your kidneys are functioning properly and reveal any abnormalities that would suggest acute kidney injury.

Acute Kidney Failure Complications

Acute kidney failure can sometimes cause complications. These include:

• Fluid buildup. Acute kidney failure can sometimes cause a buildup of fluid in your body. If fluid builds up in your lungs, this can cause shortness of breath.
• Chest pain. If the lining that covers your heart becomes inflamed, you may have chest pain.
• Acidic blood . If your blood has too much acid due to acute kidney failure, you can end up with nausea, vomiting, drowsiness, and breathlessness.
• Muscle weakness. When your body’s fluids and electrolytes are out of balance, you can get muscle weakness. In serious cases, this can lead to paralysis and heart rhythm problems.
• Permanent kidney damage. Acute kidney failure can become chronic and your kidneys will stop working almost entirely or completely. This is called end-stage renal disease. If this happens, you will need to go on permanent dialysis or get a kidney transplant.
• Death. Acute kidney failure can lead to loss of kidney function that is so bad, it can cause death.

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Complications Of Acute Kidney Injury

The most serious complications of acute kidney injury are:

• high levels of potassium in the blood in severe cases, this can lead to muscle weakness, paralysis and heart rhythm problems
• fluid in the lungs
• acidic blood which can cause nausea, vomiting, drowsiness and breathlessness

Page last reviewed: 25 February 2019 Next review due: 25 February 2022

Treatment Of Acute Kidney Injury

• Treating any treatable causes

• Restricting or adjusting doses of drugs eliminated through the kidneys

• Sometimes dialysis

Some complications of acute kidney injury are serious and may even be life-threatening. People may need to be treated in a critical care unit .

Any treatable cause of acute kidney injury is treated as soon as possible. For example, if obstruction is the cause, a catheter , cystoscopy , or surgery may be needed to relieve the obstruction.

Often, the kidneys can heal themselves, especially if the kidney injury has existed for only a few days and there are no complicating problems such as infection. During this time, measures are taken to prevent the decreased kidney function from causing serious problems. Such measures may include the following:

• Restricting use of certain drugs that may be harsh on the kidneys

• Restricting fluids, sodium, phosphorus, and potassium in the diet

• Maintaining good nutrition

• Giving drugs if blood levels of potassium or phosphate are too high

• Giving dialysis

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Clinical Presentation History And Physical Exam

Clinical presentation of acute kidney injury varies with severity and varies with prerenal, renal and postrenal causes . Patients with mild to moderate acute kidney injury are usually asymptomatic and identifiable by laboratory testing. Severe cases would present with vomiting, confusion, fatigue, anorexia, nausea, weight gain or edema . Decline in mental status, asterixis or neurologic symptoms can be indicative of uremic encephalopathy, anemia or bleeding caused by uremic platelet dysfunction .

• CBC: elevated leukocytes decreased erythrocytes , decreased hemoglobin , decreased Hematocrit normal MCV
• Liver function test were normal
• Creatinine
• Venous blood gas: decreased pH , decreased bicarbonate , pCO2 and lactate
• Electrolytes: elevated potassium , decreased sodium , decreased chloride , elevated glucose

Figure 1. ECG of patient showing Sinus Rhythm and peaked T waves in V2, V3, and V4, an early manifestation of hyperkalemia. Other manifestations include prolonged PR segment, loss of P wave, bizarre QRS complexes and sine wave.

Figure 2. Ultrasound imaging showing moderate hydronephrosis, areas of anechoic fluid indicated by red arrows.

CT Imaging

Figure 3. A) Pelvic CT showing bladder with diffuse wall thickening with a posterior globular neoplasm. B) Pelvic CT showing bladder with calculi within the neoplasm. C) Abdominal CT showing moderate bilateral hydronephrosis.

Direct Damage To The Kidneys

Causes can include:

• multiple myeloma, a cancer that affects plasma cells, a type of white blood cells
• , a life threatening response to an infection
• vasculitis, a rare condition that causes scarring and inflammation in the blood vessels
• scleroderma, a group of diseases that involve the connective tissue supporting internal organs
• interstitial nephritis, a condition that entails the swelling of the spaces between small kidney tubules caused by an allergic reaction to certain medications
• conditions that produce damage and inflammation in the tubules, filtering units, or small blood vessels of the kidneys, such as glomerulonephritis, which affects the filtering part of the kidneys

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What Are The Signs And Symptoms Of Aki

You may not have any symptoms with early or mild AKI. As AKI progresses, you may have any of the following:

• Swelling in your arms, legs, or feet
• Weakness, drowsiness, or no appetite
• Nausea, flank pain, muscle twitching or muscle cramps
• Itchy skin, or your breath or body smells like urine
• Behavior changes, confusion, disorientation, or seizures