Acute kidney Injury

This chart presents a summary of recognition and management of AKI - acute kidney injury ( previously known as renal failure ).Characterized by a decline in renal excretory function over hours or days that can result in failure to maintain fluid , electrolyte and acid-base homeostasis ( AKI )

Seen in about 13-22 % % of hospitalized patients AKI has replaced the concept of renal failure Higher incidence and mortality in ICU patients Associated with serious short- and long term complications Acute tubular necrosis ( ATN ) accounts for majority ( 45-70 % ) of cases of AKI Often asymptomatic and only diagnosed by lab tests

Rise in serum creatinine of 26 micromol / L or greater within 48 hrs 50 % or greater rise in serum creatinine known or presumed to have occurred within the past 7 days Fall in urine output to less than 0.5 ml /kg /hour for more than 6 hrs

pre-renalReduced renal perfusion eg hypovolemiahaemorrhagesepsis3rd spacing of fluidsover diuresusheart failure Renal vasoconstriction eghypercalcemiacatecholamines Impaired renal autoregulationNSAIDsACE-i / ARBCyclosporine Hepatorenal syndrome- unexplained and progressive ↑↑ in plasma creatinine in advanced liver dis renal- Acute tubular necrosisIschaemic and Toxic Rapidly progressive Gl-Nephritis Interstitial nephritis Vascular diseasesvasculitisthrombosisathero/ thromboembolismdissection...