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Acute kidney injury (AKI), previously known as acute renal failure, is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a buildup of waste products in the blood and can lead to complications if not treated promptly. The kidneys play a vital role in the body by filtering waste from the blood. When AKI occurs, the kidneys are suddenly unable to filter blood effectively.
Causes of Acute Kidney Injury
There are several potential causes of AKI. Some common causes include:
Dehydration – Not drinking enough fluids can decrease blood flow to the kidneys and cause them to malfunction. Dehydration often occurs due to diarrhea, vomiting, or excessive sweating.
Medications – Certain medications can potentially damage kidney tissue or interfere with blood flow. Common culprits include antibiotics, blood pressure medications, chemotherapy drugs, and over-the-counter pain relievers if taken in excess.
Sepsis – A systemic bacterial infection in the bloodstream called sepsis can reduce blood flow to the kidneys. Sepsis is a medical emergency that requires prompt treatment.
Surgery or Trauma – Major surgery, especially cardiac surgery, can sometimes cause Acute Kidney Injury due to a temporary decrease in blood pressure or kidney tissue damage. Physical trauma to the kidneys is also a risk factor.
Low Blood Pressure – Conditions that decrease blood pressure, such as severe heart failure, blood loss from injury or surgery, or bleeding in the abdominal cavity, can reduce blood flow to the kidneys.
Toxic Ingredients – Some toxic substances like heavy metals (e.g. mercury, cadmium), herbal supplements, ethylene glycol (antifreeze), or street drugs (e.g. heroin) can poison the kidneys and cause injury.
Pre-Existing Kidney Disease – People with chronic kidney disease are at higher risk of developing AKI from any cause like surgery or medication toxicity. Kidneys that are already compromised may fail more easily.
Symptoms of AKI
The main symptoms of AKI usually develop over a period of hours to days and may include:
– Decreased urine output or no urine formed at all
– Fatigue and weakness
– Nausea and vomiting
– Swelling of feet and ankles
– Shortness of breath
– Confusion or changes in mental status
– Severe pain in the flank area of the back
– Chest pain if fluid builds up around the lungs
– Irregular heartbeat
The symptoms of AKI depend on the underlying cause and severity. In severe cases, complications such as fluid overload, dangerous electrolyte disturbances, and metabolic acidosis may require urgent dialysis treatment.
Diagnosis and Tests for AKI
If a patient exhibits symptoms of AKI, their doctor will obtain a thorough medical history and physical exam. Several lab tests can help diagnose and determine the severity of AKI:
– Complete blood count (CBC) – May show an increased white blood cell count if infection is present.
– Basic metabolic panel (BMP) – Measures electrolytes, BUN, and creatinine levels to assess kidney function.
– Urinalysis – Checks for red blood cells, white blood cells, or casts in the urine which can indicate kidney damage.
– Blood cultures – May grow infectious bacteria if sepsis is suspected.
– Renal ultrasound – Images the kidneys to detect abnormalities, kidney stones, or bleeding.
Treatment Options for AKI
Treatment for AKI focuses on quickly identifying and correcting the underlying cause while managing symptoms and complications. Strategies may include:
– Intravenous fluids – To rehydrate and restore adequate blood pressure and flow to the kidneys.
– Medications – Such as antibiotics for infection, blood pressure medications to ensure kidney perfusion.
– Dialysis – Removal of waste if kidneys are unable to filter, buying time for recovery. Hemodialysis cleans the blood outside the body.
– Intensive care – For management of life-threatening complications in a critical care setting.
– Kidney biopsy – Rarely done to help diagnose kidney disease as the cause.
– Surgery – To remove or bypass blocked areas, drain infected areas.
Fortunately, with prompt treatment, acute kidney injury is often reversible and kidney function recovers fully in most cases without permanent impairment. However, if underlying chronic kidney disease is present, complete recovery may be less likely. With severe AKI, dialysis may be required long term or a kidney transplant may become necessary.
Preventing Acute Kidney Injury
While some causes of AKI are unavoidable, there are steps anyone can take to help prevent kidney injury:
– Stay well hydrated by drinking water regularly.
– Manage chronic health conditions well through lifestyle changes and medications.
– Work closely with your healthcare provider to monitor kidney function when taking medications.
– Avoid self-medicating with over-the-counter pain relievers for long periods or in high doses.
– Seek immediate medical care if experiencing severe diarrhea, vomiting, infection, or other illnesses.
– Wear protective gear when working with toxic chemicals and avoid recreational drug use.
Overall, understanding risk factors and warning signs of AKI allows for potentially dangerous causes to be addressed promptly before serious damage occurs. With diagnosis and treatment from a healthcare professional, full recovery is often the outcome in cases of AKI.
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