Acute Kidney Injury

Renal & Urinary System


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"Acute kidney injury (AKI) occurs when a decrease in kidney function causes accumulation of the products of metabolism. It can be classified into pre-renal, intrinsic, and post-renal (i.e., obstructive) forms.\n\nPre-renal and post-renal AKI are a consequence of extra-renal disease. Intrinsic AKI represents true kidney disease and can be categorized by the component of the kidney that is primarily affected: tubular, glomerular, interstitial, or vascular."}]}
{"ops":[{"insert":"No symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Most patients with mild to moderate AKI are asymptomatic. Such individuals are diagnosed with AKI only after laboratory testing."}]}
{"ops":[{"insert":"Pre-renal AKI: reduced fluid intake"},{"insert":"\n"}]}
{"ops":[{"insert":"Reduced fluid intake causes intravascular volume depletion, while renal arterial pressures may also be impacted. Renal perfusion is correspondingly lowered, resulting in a reduced glomerular filtration rate (GFR) and pre-renal AKI."}]}
{"ops":[{"insert":"Pre-renal AKI: volume loss"},{"insert":"\n"}]}
{"ops":[{"insert":"Severe volume loss can occur due to vomiting, diarrhea, diuretic overuse, burns, or hemorrhage. Here too, intravascular volume depletion and a reduction in renal arterial blood pressures can give rise to pre-renal AKI.\n\nIf prolonged and severe hypoperfusion occurs, ischemic injury to the renal tubules may also result, giving rise to acute tubular necrosis (ATN)."}]}
{"ops":[{"insert":"Pre-renal AKI: medications"},{"insert":"\n"}]}
{"ops":[{"insert":"Medications such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause pre-renal AKI due to volume depletion and\/or impairment of renal perfusion."}]}
{"ops":[{"insert":"Pre-renal AKI: heart failure"},{"insert":"\n"}]}
{"ops":[{"insert":"Pre-renal AKI can occur as a consequence of heart failure; this is termed cardiorenal syndrome."}]}
{"ops":[{"insert":"Intrinsic AKI: hematuria"},{"insert":"\n"}]}
{"ops":[{"insert":"The presence of hematuria may indicate nephritic syndrome, a key cause of intrinsic AKI."}]}
{"ops":[{"insert":"Intrinsic AKI: medications"},{"insert":"\n"}]}
{"ops":[{"insert":"Antibiotics, acyclovir, phenytoin, interferon, proton pump inhibitors (PPI) and NSAIDs can cause ATN and acute interstitial nephritis (AIN)."}]}
{"ops":[{"insert":"Intrinsic AKI: contrast agent use"},{"insert":"\n"}]}
{"ops":[{"insert":"Use of an intravascular contrast agent (as an adjunct for imaging studies) can result in contrast-induced AKI, a form of intrinsic AKI.\n\nRisk factors include co-existing chronic kidney disease (CKD), diabetes mellitus, NSAID therapy, a low circulatory volume, and the use of a large amount of contrast."}]}
{"ops":[{"insert":"Intrinsic AKI: symptoms of autoimmune disease"},{"insert":"\n"}]}
{"ops":[{"insert":"Certain rheumatological conditions (e.g. systemic lupus erythematosus) and autoimmune disorders (e.g. Goodpasture\u0027s syndrome) can give rise to intrinsic AKI. Their symptoms should be looked for."}]}
{"ops":[{"insert":"Intrinsic AKI: liver failure"},{"insert":"\n"}]}
{"ops":[{"insert":"Liver failure can also result in AKI; this is termed hepatorenal syndrome."}]}
{"ops":[{"insert":"Post-renal AKI: voiding symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Symptoms such as urgency, hesitancy, intermittent flow, anuria, or polyuria may indicate post-renal AKI. In this, an obstruction to the urinary flow causes increased intra-tubular pressure and a correspondingly decreased GFR.\n\nThe obstruction can be at any level of the urinary system, from the renal tubule to the urethra. Benign prostatic hypertrophy (BPH) is the most common such etiology."}]}
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"Acute kidney injury (AKI) occurs when a decrease in kidney function causes accumulation of the products of metabolism. It can be classified into pre-renal, intrinsic, and post-renal (i.e., obstructive) forms.\n\nPre-renal and post-renal AKI are a consequence of extra-renal disease. Intrinsic AKI represents true kidney disease and can be categorized by the component of the kidney that is primarily affected: tubular, glomerular, interstitial, or vascular."}]}
{"ops":[{"insert":"No symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Most patients with mild to moderate AKI are asymptomatic. Such individuals are diagnosed with AKI only after laboratory testing."}]}
{"ops":[{"insert":"Pre-renal AKI: reduced fluid intake"},{"insert":"\n"}]}
{"ops":[{"insert":"Reduced fluid intake causes intravascular volume depletion, while renal arterial pressures may also be impacted. Renal perfusion is correspondingly lowered, resulting in a reduced glomerular filtration rate (GFR) and pre-renal AKI."}]}
{"ops":[{"insert":"Pre-renal AKI: volume loss"},{"insert":"\n"}]}
{"ops":[{"insert":"Severe volume loss can occur due to vomiting, diarrhea, diuretic overuse, burns, or hemorrhage. Here too, intravascular volume depletion and a reduction in renal arterial blood pressures can give rise to pre-renal AKI.\n\nIf prolonged and severe hypoperfusion occurs, ischemic injury to the renal tubules may also result, giving rise to acute tubular necrosis (ATN)."}]}
{"ops":[{"insert":"Pre-renal AKI: medications"},{"insert":"\n"}]}
{"ops":[{"insert":"Medications such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause pre-renal AKI due to volume depletion and\/or impairment of renal perfusion."}]}
{"ops":[{"insert":"Pre-renal AKI: heart failure"},{"insert":"\n"}]}
{"ops":[{"insert":"Pre-renal AKI can occur as a consequence of heart failure; this is termed cardiorenal syndrome."}]}
{"ops":[{"insert":"Intrinsic AKI: hematuria"},{"insert":"\n"}]}
{"ops":[{"insert":"The presence of hematuria may indicate nephritic syndrome, a key cause of intrinsic AKI."}]}
{"ops":[{"insert":"Intrinsic AKI: medications"},{"insert":"\n"}]}
{"ops":[{"insert":"Antibiotics, acyclovir, phenytoin, interferon, proton pump inhibitors (PPI) and NSAIDs can cause ATN and acute interstitial nephritis (AIN)."}]}
{"ops":[{"insert":"Intrinsic AKI: contrast agent use"},{"insert":"\n"}]}
{"ops":[{"insert":"Use of an intravascular contrast agent (as an adjunct for imaging studies) can result in contrast-induced AKI, a form of intrinsic AKI.\n\nRisk factors include co-existing chronic kidney disease (CKD), diabetes mellitus, NSAID therapy, a low circulatory volume, and the use of a large amount of contrast."}]}
{"ops":[{"insert":"Intrinsic AKI: symptoms of autoimmune disease"},{"insert":"\n"}]}
{"ops":[{"insert":"Certain rheumatological conditions (e.g. systemic lupus erythematosus) and autoimmune disorders (e.g. Goodpasture\u0027s syndrome) can give rise to intrinsic AKI. Their symptoms should be looked for."}]}
{"ops":[{"insert":"Intrinsic AKI: liver failure"},{"insert":"\n"}]}
{"ops":[{"insert":"Liver failure can also result in AKI; this is termed hepatorenal syndrome."}]}
{"ops":[{"insert":"Post-renal AKI: voiding symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Symptoms such as urgency, hesitancy, intermittent flow, anuria, or polyuria may indicate post-renal AKI. In this, an obstruction to the urinary flow causes increased intra-tubular pressure and a correspondingly decreased GFR.\n\nThe obstruction can be at any level of the urinary system, from the renal tubule to the urethra. Benign prostatic hypertrophy (BPH) is the most common such etiology."}]}

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