* sudden or often reversible loss of kidney function

* develop over days or weeks

* accompanied by a reduction in urine volume

* causes of AKI classified into 3 subtypes:

* Pre-renal = when kidney perfusion is reduced
* Renal = when the primary insult affects the
kidney itself

* Post-renal = when there is obstruction to

urine flow

Pre-renal

Renal

Post-renal

- Renal artery
stenosis

- Glomerulonephritis

- Urinary Calculi

- Drugs such as
NSAIDS and
ACE inhibitors

- Acute Tubular
Necrosis

- Benign Prostatic
enlargement

- Blood loss

-Interstitial nephritis

- Prostate cancer

- Sepsis

- Small-vessel
vasculitis

- Cervical cancer

-Dehydration

-Urethral stricture

*postural hypotension
*tachycardia
*thirst
*decreased urine output
*dizziness
*vomiting
*diarrhea
*polyuria
*hemorrhage

* hematuria
* proteinuria
* leucocyturia

* urgency
* frequency
* hesitancy
* flank pain
* hematuria

* KDIGO (Kidney disease: improving global

outcome)

* RIFLE (Risk, injury, failure, loss, end

stage)

* Full blood count

* C-reactive protein
* Culture and sensitivity
* Urea and electrolytes
* Urinalysis
* Arterial blood gas
* Autoantibodies (Eg: Antineutrophil cytoplasmic
antibody (ANCA))

*Renal ultrasonography = obstruction & hydronephrosis

*Chest X-ray = pulmonary edema in fluid overload
*ECG
*Aortorenal angiography = renal artery stenosis and certain cases
of necrotizing vasculitis

*Renal biopsy = Can be useful in identifying intrarenal causes of

AKI

* Volume overload
* Furosemide can be used to correct volume

overload when patients are still responsive; this

often requires high intravenous (IV) doses.

* Hyperkalemia
* Approaches to lowering serum potassium include
the following:

* Decreasing the intake of potassium in diet or tube

feeds

* Promoting intracellular shifts in potassium with

insulin, dextrose solutions, and beta agonists

* Nephrotoxic agents

* All nephrotoxic agents (eg, radiocontrast agents,

antibiotics with nephrotoxic potential, heavy
metal preparations, cancer chemotherapeutic
agents, NSAIDs) should be avoided or used with
extreme caution.
* Similarly, all medications cleared by renal
excretion should be avoided, or their doses
should be adjusted appropriately.

* Dietary Modification

*Restriction of salt and fluid becomes crucial in

the management of oliguric renal failure,

wherein the kidneys do not adequately excrete
either toxins or fluids.
*Because potassium and phosphorus are not
excreted optimally in patients with AKI, blood
levels of these electrolytes tend to be high.
Restriction of these elements in the diet may be
necessary, with guidance from frequent
measurements.

* Renal tract obstruction

* catheterisation in urethral obsturction
* ureteric stent

* Dialysis
* for patients with :
* refractory pulmonary edema
* persistent hyperkalaemia(>7mmol/L)
* severe metabolic acidosis(pH<7.2)
* uraemic complications such as encephalopathy
* uraemic pericarditis(pericardial rub)
* drug overdose(eg:lithium)

* Renal replacement therapy

* for patient who are not showing signs of recovery