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Acute Kidney Injury – A Simple Emergency Approach to AKI

Intrarenal causes of AKI are usually considered only after pre-renal and post-renal causes have been ruled out. The “can’t miss” diagnosis... in a patient with AKI is nephritic syndrome. Thus it is important to get a urine dip to look for protein and blood in all patients with AKI.

Nephritic syndrome presents as: acutely elevated Cr with hypertension, hematuria, proteinuria and no obvious pre-renal or post-renal cause. Other important causes of renal AKI to consider... include: Nephrotoxic medications (ACEi, NSAIDs, Gentamicin etc.), Acute Tubular Necrosis (ATN) (rhabdomyolysis, hemolysis, tumor lysis syndrome), Renal thrombosis.

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Articles of Interest

Acute Kidney Injury (AKI)

Intra-renal AKI occurs when there is a structural or functional change at the level of the nephron. This can occur independently or as a transformation of a pre-renal AKI.

Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers

Pre-renal AKI is a syndrome of renal hemodynamic deficit in which kidney structures are preserved whilst intrinsic forms feature parenchymal damage, most commonly of the tubular structures. Consequently, pre-renal AKI is associated with a more favorable clinical outcome than intrinsic AKI.

Intrinsic Acute Kidney Injury

Intrinsic or intrarenal acute kidney injury (AKI), which used to be called acute renal failure, occurs when direct damage to the kidneys causes a sudden loss in kidney function. The treatment of intrinsic acute kidney injury includes identifying and correcting the cause of the kidney injury. The most common causes of intrinsic acute kidney injury are acute tubular necrosis (ATN), acute glomerulonephritis (AGN), and acute interstitial nephritis (AIN).

Intrinsic Acute Kidney Injury

Acute kidney injury (AKI) in the intensive care unit (ICU) can be the result of a wide range of disease processes, so that it is likely to be encountered by physicians from all specialties. The increasing recognition of the overlap between critical care medicine and nephrology has resulted in what nowadays is called critical care nephrology

Intrinsic Renal Disease

In patients admitted to intensive care units, sepsis accounts for 35 to 50% of cases of acute renal failure, usually acute tubular necrosis. In sepsis, arterial vasodilatation due to cytokines that upregulate inducible nitric oxide synthase expression leads to arterial underfilling and may be coupled with renal vasoconstriction due to endothelin release from elevated tumor necrosis factor-alpha. Patient with pre-existing renal disease, hypertension, peripheral vascular disease, diabetes mellitus, cardiac disease, advanced age and liver disease are at increased risk of developing intrinsic renal impairment, particularly acute tubular necrosis, especially after surgery.

Intrinsic Renal Failure - Causes, Symptoms, Diagnosis, and Treatment

Intrinsic renal failure is a complex medical condition that can significantly affect an individual's health and well-being. It can have various causes, and understanding its underlying mechanisms is essential for effective diagnosis and treatment. Despite its challenging prognosis, there are several treatment options available, ranging from medication to dialysis and kidney transplant. Early detection and prompt treatment are crucial for improving outcomes and reducing the risk of complications. Managing intrinsic renal failure requires a collaborative approach between healthcare providers, patients, and their families, using the latest medical research and technology to help improve the outcomes for everyone affected by this condition.

Kidney Boy on Acute Kidney Injury: Myths & Musings

Intra-Renal: Acute Tubular Necrosis – the most common, acute interstitial nephritis / drug toxicities (vancomycin, aminoglycosides, etc.), glomerulonephritis, vasculitis.