Causes of Acute Kidney Injury
Some common causes that can lead to AKI include severe dehydration due to vomiting, diarrhea or inadequate fluid intake, nonsteroidal anti-inflammatory drug (NSAID) use, urinary tract obstruction, exposure to kidney toxins like certain antibiotics, contrast dyes used during medical imaging tests and blood pressure medicines. Sepsis, or an infection leading to low blood pressure, and cardiovascular surgery like heart bypass surgery are also recognized causes of AKI. People with pre-existing chronic kidney disease or other co-existing medical illnesses like diabetes and heart disease are more prone to AKI.
Diagnosing Acute Kidney Injury
AKI is usually diagnosed based on sudden onset and rise in serum creatinine level and decrease in urine output. Creatinine is a waste product generated from muscle breakdown that is removed from the body by normally functioning kidneys. A blood test is done to check the level of creatinine. A rise of more than 0.3 mg/dL from baseline or an increase of 1.5 times or 50% from baseline level is considered diagnostic of AKI as per the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Urine output of less than 0.5 mL/kg/hour for 6-12 hours is also indicative of AKI. Other diagnostic tests like urine analysis and ultrasound may be done to identify the underlying cause.
Treating the Underlying Cause
The primary Acute Kidney Injury Treatment is to identify and remove or treat the underlying cause if possible. For example, treating the infection in sepsis-induced AKI or removing any obstructions in the urinary tract that is impeding normal flow of urine. Discontinuing nephrotoxic medications, aggressive fluid resuscitation in case of severe dehydration and ensuring proper blood pressure control are important initial steps in AKI management. Antibiotics may be used if infection is the cause.
Dialysis for Waste Removal
When the kidneys are unable to remove waste products and regulate fluid and electrolyte balance due to dysfunction, dialysis has to be started. Hemodialysis involves filtering of blood through a dialyzer machine to rid it of toxins, extra electrolytes and fluid. It is done 2-3 times a week for few hours each time depending on the severity of AKI. Peritoneal dialysis uses peritoneum, the lining of the abdomen as a natural filter by infusing sterile fluid into the abdominal cavity and draining it after a few hours. This process is repeated several times daily for continuous waste removal. Both hemodialysis and peritoneal dialysis help support kidney function till it recovers.
Fluid Management
Fluid status also needs close monitoring and management in acute kidney injury treatment. A negative fluid balance through reduced oral intake and dialysis avoids fluid overload, pulmonary and peripheral edema. At the same time, maintaining adequate circulating volume through intravenous fluids prevents hypotension. Diuretics can be used judiciously to promote urine output and fluid loss if needed. Sodium and potassium levels have to be supplemented or restricted as per blood tests under medical guidance.
Nutritional Support
Protein-calorie malnutrition is common in AKI due to anorexia, metabolic changes, inflammation and medications. Enteral nutrition through a feeding tube passing into the stomach or intestine helps meet nutritional needs instead of complete fasting or low residue diet alone. Parenteral route may be opted if enteral feeding is not feasible. Adequate protein intake is important for recovery. Vitamins, minerals and calorie intake have to be customized according to etiology, severity of AKI and presence of other comorbidities.
Preventing Complications
Potential complications from AKI have to be avoided as much as possible. These include fluid overload, electrolyte imbalances, hypoxemia, infections, gastrointestinal bleeding and myopathy. Careful fluid balance, nutritional management, early mobilization, prophylactic antibiotics and low molecular weight heparin as required can help prevent some common complications. Treating associated conditions like delirium and maintaining blood glucose control are other supportive measures undertaken.
Spontaneous recovery is possible in mild AKI cases. But recovery in severe AKI depends on the underlying cause. Those who do not recover or require prolonged dialysis support may progress to end-stage renal disease necessitating long-term dialysis or kidney transplant. With prompt diagnosis and optimal management, acute kidney injury treatment outcomes are improving. But close long-term nephrology follow-up is warranted even after apparent recovery. Overall prognosis depends on age, comorbidities and severity of initial insult, and how quickly it was recognized and appropriately treated.
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