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    An Overview Of: Acute Kidney Injury (Aki: Hasan Basri

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    Dz Putra
    Acute Kidney Injury (AKI) is defined as an abrupt decrease in kidney function over a period of less than 7 days. It is characterized by increased serum creatinine and blood urea nitrogen levels, decreased urine output, and fluid overload. The causes of AKI include prerenal issues like shock that decrease renal blood flow, intrinsic renal damage, and postrenal obstruction of the urinary tract. Complications of AKI involve metabolic acidosis, electrolyte imbalances, and heart failure due to fluid overload. Patients require hospitalization, especially in the intensive care unit, for management which focuses on fluid, electrolyte, and acid-base balance stabilization along with renal replacement therapies like dialysis when needed

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    An Overview Of: Acute Kidney Injury (Aki: Hasan Basri

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    Dz Putra
    59 views22 pages
    Acute Kidney Injury (AKI) is defined as an abrupt decrease in kidney function over a period of less than 7 days. It is characterized by increased serum creatinine and blood urea nitrogen levels, decreased urine output, and fluid overload. The causes of AKI include prerenal issues like shock that decrease renal blood flow, intrinsic renal damage, and postrenal obstruction of the urinary tract. Complications of AKI involve metabolic acidosis, electrolyte imbalances, and heart failure due to fluid overload. Patients require hospitalization, especially in the intensive care unit, for management which focuses on fluid, electrolyte, and acid-base balance stabilization along with renal replacement therapies like dialysis when needed

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    Acute Kidney Injury (AKI) is defined as an abrupt decrease in kidney function over a period of less than 7 days. It is characterized by increased serum creatinine and blood urea nitrogen levels, decreased urine output, and fluid overload. The causes of AKI include prerenal issues like shock that decrease renal blood flow, intrinsic renal damage, and postrenal obstruction of the urinary tract. Complications of AKI involve metabolic acidosis, electrolyte imbalances, and heart failure due to fluid overload. Patients require hospitalization, especially in the intensive care unit, for management which focuses on fluid, electrolyte, and acid-base balance stabilization along with renal replacement therapies like dialysis when needed

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    59 views22 pages

    An Overview Of: Acute Kidney Injury (Aki: Hasan Basri

    Uploaded by

    Dz Putra
    Acute Kidney Injury (AKI) is defined as an abrupt decrease in kidney function over a period of less than 7 days. It is characterized by increased serum creatinine and blood urea nitrogen levels, decreased urine output, and fluid overload. The causes of AKI include prerenal issues like shock that decrease renal blood flow, intrinsic renal damage, and postrenal obstruction of the urinary tract. Complications of AKI involve metabolic acidosis, electrolyte imbalances, and heart failure due to fluid overload. Patients require hospitalization, especially in the intensive care unit, for management which focuses on fluid, electrolyte, and acid-base balance stabilization along with renal replacement therapies like dialysis when needed

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    of 22

    AN OVERVIEW OF :

    ACUTE KIDNEY INJURY (AKI

    Hasan Basri
    ACUTE KIDNEY INJURY (AKI)
    (Cedera Ginjal Akut)

    Another term : Acute Renal Failure


    Many references / literatures still use this term

    DEFINITION :
    AKI is an abrupt (less then 7 days) and sustained decrease in
    kidney function.
    • changes in blood biochemistry : increased of serum
    creatinine, blood urea nitrogen
    • decreased of urine out put in 80-90% cases (10-20%
    normal or increase) or both
    • kidney function used to be normal
    When the patient has a previous episode of kidney disease,
    the term is : Acute on Chronic Kidney Injury (ACKI)
    CLASIFICATION
    AKI classified according to degree and outcome of renal
    function by RIFLE criteria
    R = Risk I = Injury F = Failure
    L = Loss E = End Stage

    1. Risk of Renal Dysfunction (R)


    • serum creatinine increased 1.5 fold, or
    • GFR decreased by more than 25%
    • Less than 0.5 ml/kg/h of urine production for 6 hours
    2. Injury of the Kidney (I)
    • doubling of serum creatinine or
    • GFR decreased by more by 50% or
    • urine production less than 0.5 ml/kg/h in 12 hours
    3. Failure of Kidney Function
    • serum creatinine increased 3 fold, or
    • GFR decreased by more than 75%
    • less than 0.3 ml/kg/h of urine for 24 hours
    4. Loss of Kidney Function
    • Complete loss of kidney function for longer
    than 4 weeks
    5. End Stage Renal Disease
    • The need for dialysis for longer than 3 month
    GFR Criteria AND/OR Urine output Criteria

    Risk of renal 50% decrease in creatinine or Urine output < 0.5 ml/kg/hr for
    dysfunction > 25% decrease in GFR at least 6 hours

    Two-fold increase in Urine output < 0.5 ml/kg/hr for


    Injury to the creatinine or > 50% at least 12 hours
    kidney decrease in GFR

    Three-fold increase in creatinine Urine output < 0.3 ml/kg/hr


    Failure of or > 75% decrease in GFR or for 24 hours (or anuria for
    creatinine > 350 (acute rise) 12 hours)
    kidney function

    Loss of kidney Loss of kidney function > 4 weeks but


    function < 3 months

    ERF Established renal failure (loss of


    function > 3 months)

    Acute renal failure (ARF) classified according to degree and outcome by RIFLE criteria
    CAUSES OF AKI
    Causes of AKI divided into three matter :
    1. Prerenal :
    Decreased of renal perfusion (hypoperfusion)
    2. Renal (Intrinsic)
    Damage of parenchyma of the kidney (glomeruli,
    tubules, intra-renal vasculature, interstitial nephritis)
    3. Post-renal
    Obstruction of urinary tract
    PRERENAL CAUSES OF AKI
    1. Shock :
    • cardiogenic ahock
    • distributive shock (e.g.sepsis, anaphylactic)
    2. Hypovolemia – hypovolemic shock
    • haemorhage
    • gastrointestinal loss (vomiting, diarrhea)
    • cutaneous losses (e.g.burns)
    3. Renal hypoperfusion
    • renal artery stenosis
    • hepatorenal syndrome
    4. Changes of water distribution (oedema)
    • congestive hearth failiure
    • hepatic failure
    • nephrotic syndrome
    RENAL / INTRINSIC CAUSES OF AKI
    1. Glomerular disease
    • glomerulonephritis
    2. Tubular injury
    • prolonged renal hypoperfusion
    • toxin (snake venom), drugs (aminoglycosides),
    3. Vascular
    • vasculitis
    • arterial or venous thrombosis
    4. Interstitial nephritis
    • infiltrative malignancy
    • toxin (alcohol, metal)
    • infection (leptospiral)
    POST-RENAL CAUSES OF AKI
    Obstruction :
    • stone
    • urethral stricture
    • prostate hypertrophy
    • pelvic tumor
    • retroperitoneal fibrosis
    Prerenal
    Renal
    Postrenal
    DIAGNOSTIC
    1. History of disease
    • gastroenteritis, bleeding ?
    • hearth disease
    • toxin ? post infection ?
    • stone disease ?
    2. Investigation
    A. Physical examination.
    • blood pressure (hypotension/shock)
    • anemic, dehydration
    • renal colic, ballotment, full vesica urinaria
    B. Blood chemistry
    • haemoglobine, white blood cell
    • blood ureum, serum creatinine
    • potassium (K), sodium (Na)
    • blood gas analysis
    C. Radiology
    • plain photo abdomen
    • ultrasonography
    DIGNOSTIC STEP OF AKI
    Patient with :
    Oligouria / Anuria

    • Prerenal
    History of Disease • Renal
    • Post renal

    • Shock
    • ballotment
    Physical Examination
    • pain angulus
    costovertebtalis
    • full of VU
    Imaging Laboratory test • BPH
    BNO Routine
    USG Abdomen BUN/SC
    Electrolyte (K,Na
    COMPLICATIONS
    1. Volume overload

    • acute pulmonary oedema

    • acute left hearth failiure

    2. Metabolic acidosis

    3. Electrolyte imbalance

    • hyperkalemia
    MANAGEMENT
    A. Manage the initial causes / initial disease properly
    B. Patient must be hospitalized and admit in
    Intensive Care Unit
    • water, electrolyte and acid-base balance
    • antibiotic
    C. Renal Replacement Therapy
    • dialysis
    • ultrafiltration
    PREVENTION
    • Identify and treat patients most at risk
    • gastroenteritis
    • bleeding
    • hearth failure
    • pre- operation
    • drugs / toxin
    • infection
    SUMMARY
    • Acute Kidney Injury is an abruptly decrease of
    kidney function characteristic by increase of BUN,
    SC, K, and volume overload
    • The causes divided into prerenal, renal /intrinsic
    and post renal
    • The most emerging complication are metabolic
    acidosis, acute heart failure electrolyte imbalance
    • The patients must admitted to Intensive Care Unit
    • Prevention is the most important thing

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