Acute Renal Injury: Revisited

摘要

Acute kidney injury (AKI) indicates its abrupt deterioration and is defined as an increase in serum creatinine more than the baseline by 26 umol/L within 48 hours or 50% within 1 week. The latter since glomerular failure is the life-threatening one with: (a) uremic intoxication, (b) water and salt retention with fluid overload, and (c) potassium accumulation with cardiac arrest. The etiology can be pre-renal, post-renal or intrinsic. Diagnosis is established by history of new insults, physical examination for hydration status, systemic stability and manifestations of autoimmune diseases/infections as well as an initial laboratory testing for renal function (serum creatinine, electrolytes and urine routine) and kidney ultrasound. Additional specific tests are indicated to assess etiology of AKI and its associated co-morbid conditions that interacts with its management. Severity of AKI ranges from mild (stage 1) to advanced (stage 5) that requires dialytic support. Moreover, it depends on the type and duration of the insult. Prognosis depends on etiology of AKI, its co-morbid conditions and the timely interventions by the supportive medical team.