Acute kidney injury.
Chronic kidney disease
Relationships between AKI, AKD and CKD
•AKD – acute kidney disease (duration <3 months)
•AKI – acute kidney injury (subset of AKD)
•CKD – chronic kidney disease
•AKI and AKD may be superimposed upon CKD
Incidence of kidney pathology
AKI
Incidence
•20-200 cases per 1 million of general population
•7-18% hospitalized patients
•≥50% of intensive care department patients
High mortality
•5-10% in uncomplicated AKI
•50-70% in AKI secondary to other organ failure( intensive care)
•> 50% in dialysis requiring AKI
CKD
•CKD - a candidate for the 5th "killer disease"
•CKD is widespread (10-13% of the adult population)
•CKD is a lethal disease (only 1 out of 30 CKD patients survives to receive RRT, the rest die from CV complications)
•CKD is treatable (screening in risk groups, renoprotective strategy, fighting with vascular calcification)
Lewington, A. J. et al. Kidney Int. 84, 457–467 (2013) Hoste, E. A. et al. Intensive Care Med. 41, 1411–1423 (2015)
Selby NM et al CJASN 2012; 7(4): 533-40
Acute kidney injury
AKI as an abrupt decrease in kidney function that occurs over a period of 7 days or less. May be accompanied by electrolyte disturbances and acid-base imbalance
The cause of AKI should be determined if possible. The most important thing is to detect reversible causes
AKI criteria
•Increase in SCr of ≥ 0.3 mg/dl (≥ 26.5 µmol/l) in 48 h; OR
•Increase in SCr ≥ 1.5 fold from baseline in 7 days OR
•Oliguria< 0.5 ml/kg/h x 6 h
AKI stages (KDIGO)
Classification of AKI
•Prerenal
•Renal
•Postrenal
Risk factors of AKI
•Age (new-born, >60 years), pregnancy, delivery,
•Metabolic (gout, atherosclerosis, diabetes mellitus)
•Haemodynamic (heart failure, liver cirrhosis)
•Drugs (sulfonamides, antibiotics, etc.)
•Toxic (alcohol, narcotics)
•Traumatic (polytrauma, massive burns, cardiac surgery)
•Renal (obstructive kidney disease, nephrotic syndrome, toxemia of pregnancy, chronic renal failure)
Common causes of AKI
Clinical Presentation of AKI
•Symptoms
•Malaise
•Anorexia, Nausea and Vomiting
•Pruritus
•Dehydration
•Confusion, convulsions
•Signs
•Hypertension
•Fluid overload: peripheral oedema, SOB/ bibasal crackles/raised JVP
•Dehydration: postural hypotension, poor urine output (palpable bladder)
Diagnostic Approach in AKI
•Time of onset – prior serum creatinine
•Careful review of history and physical exam
•Comorbidities
•Medications
•Current illness (vomiting, diarrhea, blood loss, etc)
•BP, volume status, skin lesions, flank/abdominal signs