Acute Kidney Injury. Causes and Differential Diagnosis.



Read also:  Anesthetic agents and impaired renal function.

 Acute kidney injury (AKI) is defined as an abrupt or rapid loss in kidney filtration function,  that develops within 7 days. 
Main groups of causes are:

 I    PRERENAL
  • Absolute decrease in effective blood volume
    • Severe blood loss
    • Volume depletion
    • Severe burns
  • Relative decrease in blood volume (ineffective arterial volume)
    • Congestive heart failure
    • Decompensated liver cirrhosis
  • Arterial occlusion or stenosis of renal artery
  • Hemodynamic form
    • NSAIDs
    • ACE inhibitor or angiotensin-II receptor antagonists in renal-artery stenosis or congesitve heart failure


 II   INTRINSIC RENAL 
  • Vascular
    • Vasculitis, malignant hypertension
  • Acute glomerulonephritis
    • Postinfectious glomeronephritis disease caused by antibody to glomerular basement membrane
  • Acute tubular necrosis 
  • Acute interstitial nephritis
    • Ischemic
    • Nephrotoxic
      • Exogenous: Antibiotics (gentamicin), Radio contrast agents, Cisplatin
      • Endogenous: Intratubular pigments (hemoglobinuria, myoglobinuria), Intratubular proteins (myeloma), Intratubular crystals (uric acid, oxalate)


III  POSTRENAL
  • Obstruction of collecting system or extrarenal drainage
    • Bladder-outlet obstruction
    • Bilateral ureteral obstruction

Signs and symptoms depends on the the underlying cause of AKI. 

Common signs are: fatigue or loss of appetite, headache, nausea and vomiting.  Increased in the potassium level can lead to abnormal and threatening heart rhythms. Fluid imbalance lead to arterial pressure abnormalities. Pain in the back is the result of stretching of the fibrous tissue capsule surrounding the kidney. Little or no urine (oligo- or anuria).


Brief classification of causes is below. Click to enlarge:




Read also:  Anesthetic agents and impaired renal function.

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