Acute kidney injury

Physiopathology
Acute Kidney Injury
Students : 1. Cheng Chanroth , 2. Khlok Sokuntheara , 3. Shoeng Rany
4. Thak Sokhamony, 5. Kun Salim
Professor : Im Bunthoeun

Objective
 Know about definition of Acute kidney injury
 Function of kidney
 Sign and symptoms of AKI
 Know about Risk factor of AKI
 Understand about complication of AKI

Contents:
I. Introduction
II. Physiology
III. Pathophysiology
IV. Clinical feature
V. Risk Factor
VI. Diagnosis
VII. Differential diagnosis
VIII. Complication
IX. Management

I. Introduction
1. Definition
 Acute kidney injury (AKI), Previously known as acute renal failure
(ARF), is an acute decline in renal function, leading to a rise in serum
creatinine and/or a fall in urine output.

2. Epidemiology
 In US, the total number of hospitalization for AKI increased from 953,926 in
2000 to 3,959,560 in 2014.
 In UK, incidence range from 172 per million population per year up to 630 per
million population per year.
 Overall, in cidence of AKI among hospitalized patient range from 13% to 22%.

II. Physiology
1. Excretory function
a. Metabolic
b. Drug
c. Toxins
2. Homeostatic functions
a. Maintained of water balance
b. Maintained of electrolyte balance
c. Maintained of acid-base balance

3. Endocrine functions
a. Erythropoietin
b. 1.25 – Dihydroxycholecalciferol
c. Renin

 Etiologies of AKI
 Renal hypoperfusion (Pre renal)
 Disorders involving the renal parenchymal (intra renal)
 Disorders with acute urinary tract obstruction (post renal)
III. Pathophysiology

IV. Clinical feature
 The mitral symptom
 Fatigue
 Malaise
 Loss of ability to excrete water, salt and waste via kidney.

 Clinical Manifestations
 Pre renal: Decreased tissue turgor, dryness of mucous membrane,
weight loss, hypotension, oliguria or anuria, tachycardia.
 Post renal: Obstruction to urine flow, nephrolithiasis, obstructive
symptoms of BPH.
 Intra renal: Edema, presentation based on cause.
 Changes in urine vol. And serum conc. Of BUN, creatinine, potassium
and so forth..

V. Risk Factors
 Advanced age
 Diabetes mellitus
 Sodium-retaining states(Congestive heart failure, Cirrhosis,
Nephrotic syndrome).
 Sepsis
 Drug overdose.

1. History & Physical Examination
 History:
 Age
 Reduced urine production
 Vomiting
 Diarrhea
 Hemorrhage
 Diabetes mellitus
 Drug abuse
 Duration of symptoms ……
 Physical Examination
 Weight loss
 Hypotension
 Hypertension
 Tachycardia
 Poor skin turgor
 Bladder distension
 Prostate enlargement …….
VI. Diagnosis

VI. Diagnosis
2. Investigations
 Blood test: blood test help find level of:
 Creatinine :
• For male normal range (0.7 - 1.3) mg/dl
• For female normal range (0.6 - 1.1) mg/dl
 BUN(Blood urea nitrogen) : normal range (7 -20 ) mg/dl
 Phosphorus: normal range (2.5 - 4.5) mg/dl
 Potassium: normal range (3.5 - 5.2) mEq/l (mille Equivalents per liter)
 Calcium: normal range (8.5 – 10.5) mg/dl

2. Investigations
 Urine test: Na+ (Sodium), Creatinine, Osmolality.
 Imaging test:
 Renal ultrasound
 CT scan (abdomen pelvis)
Renal biopsy
Urine culture: If infection is suspected.
VI. Diagnosis

VII.Differential diagnosis
AKI CKD
Cause
 Ischemia
 Nephrotoxins
 Sepsis
 Radiocontrast
 Hypertension
 Glomerulonephritis
 Diabetes
 Urinary obstruction
 Hereditary
Duration of symptoms <90 days >90 days
Laboratory test
 Increase serum creatinine
occurs rapidly over several
days.
 Increase serum creatinine
over month to year.
Other diagnosis test
 Proteinuria is rare or in low
amounts (< 500mg/24h).
 Proteinuria is common and
high amounts (1g/24h).

VIII.Complication
 Uremia
 Hypervolemia and hypovolemia
 Hyponatremia
 Hypernatremia
 Hyperphosphatemia and hypocalcemia
 Bleeding
 Infections
 Cardiac Complication
 Malnutrition

IX. Management
 Correct hypovolaemia and optimize systemic haemodynamic status with inotropic
drugs if necessary.
 Administer glucose and insulin to correct hyperkalaemia if K+ > 6.5 mmol/L
 Consider administering sodium bicarbonate (100mmol) to correct acidosis if PH<7
 Discontinue potentially nephrotoxic drugs and reduce doses of therapeutic drugs
according to level of renal function

 Match fluid intake to urine output plus an additional 500mL to cover
insensible losses once patient is euvolaemic.
 Measure body weight on a regular basic as a guide to fluid requirements
 Ensure adequate nutritional support.
 Screen for intercurrent infections and treat promptly if present
IX. Management

Reference
 Mayoclinic : June 23, 2018
https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-
20369048
 (Step-Up Series) Steven S. Agabegi, Elizabeth D. Agabegi - Step-Up to Medicine-LWW
(2015)
 Researchgate
https://www.researchgate.net/figure/Features-that-allow-the-differential-diagnosis-of-AKI-
and-CKD_tbl2_225055682
 Sruart Ira Fox : Human Physiology
 Dee Unglaub Silverthorn : Human Physiology, An Integrated Approach, Seventh
Edition.
 Bmj-Best Practice, January 2019
https://bestpractice.bmj.com/topics/en-
gb/83?q=Acute%20kidney%20injury&c=suggested

Acute kidney injury

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