Current Clinical Management of Acute Kidney Injury

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Acute kidney injury is a common condition seen by clinicians in different settings. An article published in the Clinical Kidney Journal this 2017 provided an overview of the current diagnosis and clinical management of this condition.

An article published in the Clinical Kidney Journal this 2017 provided an overview of the current diagnostic methods and clinical management of acute kidney injury. The development of acute kidney injury is multifactorial, and several risk factors have been identified. Patients diagnosed with chronic kidney disease, impaired left ventricular systolic function, old age, diabetes mellitus, and dehydration are identified as having a high risk of developing acute kidney injury. Acute kidney injury is rarely symptomatic. The signs and symptoms of this disease are often due to a secondary pathology. The kidney injury will cause damage to other body parts and these create symptoms that lead to a diagnosis. A good history and physical examination are important to determine its underlying cause.

Diagnosing Acute Kidney Injury

Different criteria have been published for diagnosing acute kidney injury and its stages. In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) published criteria to define and stage patients depending on the changes on their serum creatinine levels and urine output. However, despite the uniform criteria, the authors state that acute kidney injury is still a clinical diagnosis and the criteria published serves only as a guide on when to initiate appropriate clinical measures to prevent further kidney damage.

The etiology, or cause of acute kidney injury, is usually divided into three groups: prerenal, renal, and postrenal. Prerenal injury is often secondary to decreased renal blood flow and glomerular filtration rate (the rate at which your kidneys are filtering blood). Common causes are hypovolemia (abnormally decreased volume of blood in the body) and decreased cardiac output. Renal injury is caused by direct damage to kidneys while post-renal injury is often due to outflow obstruction.

Recommendations for Clinicians

Despite a volume of research, no effective treatment for acute kidney injury has yet been found.  The authors recommend that clinicians aim to limit damage in patients with acute kidney injury by using crystalloid solutions instead of fluids with high chloride content and avoiding fluid overload. The treatment and management of acute kidney injury are aimed at preventing further decline in the glomerular filtration rate and minimizing the damage to the kidneys. Treating the underlying cause and restoring stability are important aspects of managing this condition. This can be achieved by providing crystalloid solutions and administering drugs which improve renal perfusion and discontinuing any drugs that may cause damage to the kidneys.

 

Written by Karla Sevilla

Resource:

Hertzberg, D., et al. (2017). Acute kidney injury – an overview of diagnostic methods and clinical management.  Clinical Kidney Journal, 10(3),  323 – 331. doi: 10.1093/ckj/sfx003

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