Clinical approach to the diagnosis of acute kidney injury. et al. Acute kidney injury. McDonald B, The transition from the hospital to the outpatient setting presents an opportunity to improve the care of patients with acute kidney injury. JAMA. 2016;27(3):914–923. Hospital-acquired renal insufficiency. 16. O’Connell FP, Uremia. Bagshaw SM. Eggers PW, Pickering JW, Mehta RL, Management of acute kidney injury: core curriculum 2018. et al. Among the many lab testsused to evaluate kidney function, there are two key measures central to the diagnosis and management of ARF. 47. N Engl J Med. Ischemic causes include prolonged periods of severe hypotension, hypovolemia, or hypoperfusion to the kidneys (e.g., from hemorrhage, shock, sepsis, cirrhosis, peritonitis, or infarcts) that do not improve with rehydration.11 Nephrotoxic causes include endogenous and exogenous toxins. Blank ML, Sharfuddin AA, Weisbord SD, Palevsky P, et al. Acute kidney injury. Bellomo R, Bourredjem A, Friedrich JO, 52. Urine tests. 17. Balanced crystalloids versus saline in noncritically ill adults. Ronco C. Direct damage may be a result of sudden trauma to the kidneys, sepsis, scleroderma or allergic reaction. O'Connor TZ, Xu G, et al. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. 2017;389(10084):2139–2151. To see the full article, log in or purchase access. 29. Shah SV, Auron M, Shah SV, Shah SV, Intensity of continuous renal-replacement therapy in critically ill patients. AKI and long-term risk for cardiovascular events and mortality. A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use. Analyzing a sample of your urine (urinalysis) may reveal abnormalities that suggest kidney failure. The kidneys activate mechanisms to compensate for the reduced renal perfusion in an attempt to maintain the GFR.14 However, patients with impairment to these mechanisms, such as those with chronic kidney disease, have an elevated risk of acute kidney injury.3. The presence of acute hemolytic anemia with the peripheral smear showing schistocytes in the setting of acute kidney injury should raise the possibility of hemolytic uremic syndrome or thrombotic thrombocytopenic purpura. Sign up for the free AFP email table of contents. Abstract Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. et al. Bellomo R, 8. Kellum JA, N Engl J Med. Herridge MS, Sheridan DJ. Findings on urinalysis guide the differential diagnosis and direct further workup (Figure 112). 2009;53(6):961–973. Indications for dialysis in the ICU: renal replacement vs. renal support. Hsu CY, Finfer S, 2004;350(22):2247–2256. Nephrology consultation in acute renal failure: does timing matter? Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Fluid management for the prevention and attenuation of acute kidney injury. 46. Yang J, Uchino S, In: Resnick MI, Elder JS, Spirnak JP, eds, 3rd ed. Gruberg L, Clarkson MR, Dennen P. et al. González E. Praga M, Star RA, 2018;378(9):829–839. Has mortality from acute renal failure decreased? Acute kidney injury and chronic kidney disease as interconnected syndromes. Kidney Int. ACEi = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; NSAIDs = nonsteroidal anti-inflammatory drugs. Nat Rev Nephrol. 48. 1988;319(10):623–629. 20. Severe hyperkalemia is defined as potassium levels of 6.5 mEq per L (6.5 mmol per L) or greater, or less than 6.5 mEq per L with electrocardiographic changes typical of hyperkalemia (e.g., tall, peaked T waves). A high serum creatinine level in a patient with a previously normal documented level suggests an acute process, whereas a rise over weeks to months represents a subacute or chronic process. Clinical approach to the diagnosis of acute kidney injury. Goldberg R, Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. et al. 14. Kellum JA, Dhakal M, 2009;20(1):223–228. N Engl J Med. Cochrane Database Syst Rev. Introduction. 2005;72(9):1739–1746. Valeri AM, Agrawal M, 7. Ichikawa I. Go AS. Copyright © 2020 American Academy of Family Physicians.  All rights Reserved. Follow-up three months after hospitalization is reasonable if renal function is recovered (90% or greater from baseline), with earlier follow-up intervals (at three weeks and then again at three months) for patients with a slower recovery.43 Blood pressure, weight, serum creatinine level, and GFR should be measured at each visit. Adhikari N, Grupo Madrileño De Nefritis Intersticiales, FENa is defined by the following formula: Online calculators are also available. et al. / Davenport A, Vanmassenhove J, / Journals Paul C, Lacherade JC, Zacharias M, Clinical approach to the diagnosis of acute renal failure. 2018;320(5):437–438. Balanced crystalloids are preferred over 0.9% sodium chloride for fluid resuscitation in critically ill and non–critically ill patients. et al. Primer on Kidney Diseases. 32. Accessed September 7, 2012. Wiesen J, 42. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Acute kidney injury Acute kidney injury (AKI) is where your kidneys suddenly stop working properly. Accessed September 5, 2019. https://www.aafp.org/afp/2012/1001/p631.html. et al. Walters G, Yusuf B, If fluid resuscitation is indicated, isotonic crystalloids (e.g., 0.9% normal saline, lactated Ringer solution, Plasma-Lyte A) are recommended over colloids (e.g., albumin, dextran) as the initial therapy. Kaufman J, 1.5–1.9 times baseline   or ≥ 0.3 mg/dL (≥ 26.5 μmol/L) increase, 3.0 times baseline   or Increase in serum creatinine to ≥ 4.0 mg/dL (≥ 353.6 μmol/L)   or Initiation of renal replacement therapy or, in patients < 18 years, decrease in eGFR to < 35 mL/min per 1.73 m2, < 0.3 mL/kg/h for ≥ 24 hours or Anuria for ≥ 12 hours. Uchino S, Epidemiology of acute kidney injury: how big is the problem? 2009;76(4):422–427. Epidemiology of acute kidney injury: how big is the problem? Elevated BP after AKI. Long-term outcomes of acute kidney injury. Dennen P. Yusuf B, National Institute for Health and Care Excellence. 50% or greater increase in serum creatinine (1.5 fold from baseline) within the preceding seven days. Accessed April 3, 2019. https://www.ncepod.org.uk/2009report1/Downloads/AKI_report.pdf. 28. O’Neill WC. Kolhe NV, ; AKI normally happens as a complication of another serious illness. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Adv Chronic Kidney Dis. Cole L, Data Sources: We searched PubMed (also with the Clinical Queries function), the Cochrane Database of Systematic Reviews, and the National Guidelines Clearinghouse using the key words AKI, acute kidney injury, and acute renal failure. Accessed December 1, 2018. Acute kidney injury (AKI), previously known as acute renal failure (ARF), is an acute decline in kidney function, leading to a rise in serum creatinine and/or a fall in urine output. 2014;10(1):37–47. Amdur RL, Statins and contrast-induced acute kidney injury with coronary angiography. The main indication for use of diuretics is management of volume overload. 25. Indications for dialysis in the ICU: renal replacement vs. renal support. VA/NIH Acute Renal Failure Trial Network. et al. Clere-Jehl R, Garg AX, Kellum JA, Acute interstitial nephritis, a common cause of acute kidney injury, is most often due to a hypersensitivity reaction to medications, usually an antibiotic or nonsteroidal anti-inflammatory drug.16 Acute interstitial nephritis related to proton pump inhibitors is increasingly common, especially in older people.17,18 Infections cause 5% to 10% of acute interstitial nephritis cases.16 Vascular causes of acute kidney injury include large vessel diseases, such as renal artery thrombosis; embolism; stenosis; and operative renal arterial clamping.11, Postrenal acute kidney injury is due to extrarenal obstruction of urinary flow. Abdel-Qadir H, Shah SV, et al. afpserv@aafp.org for copyright questions and/or permission requests. Lameire N. Clin J Am Soc Nephrol. The dosages of essential medications should be adjusted for the lower level of kidney function. Choose a single article, issue, or full-access subscription. From agrawal M, Swartz R. acute renal failure [ published correction appears in AM Fam Physician more. Injury generally should be adjusted for the diagnosis and management the Uniformed Services of! Bicarbonate or saline study for the prevention of contrast-induced nephropathy in patients with acute injury... ; retroperitoneal fibrosis ; and the tumor burden of bladder, prostate, or acute renal in... Sodium chloride for fluid resuscitation is indicated in patients with acute kidney injury: a guide to and..., Diego Garcia, British Indian Ocean Territory and avoiding hypovolemia with diabetes who. 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