Advertisement

Diagnosis and Management of Acute Kidney Injury

  • Neesh Pannu
  • Matthew T. James
Chapter

Abstract

Over the last decade, there has been a paradigm shift in our understanding of acute renal failure or acute kidney injury (AKI). Initially described and defined as a complete loss of kidney function, it is now widely recognized that lesser degrees of kidney injury have important implications for health. As currently defined, AKI represents a heterogeneous clinical syndrome with multiple etiologies rather than a specific disease. However whether it occurs in critically ill patients with multisystem organ failure or in isolation, AKI is associated with high costs and adverse clinical outcomes including excess mortality, increased length of hospital stay, the development and/or progression of chronic kidney disease (CKD), and requirement for chronic dialysis in survivors [1–4]. In its most severe form (requirement for acute dialysis), AKI is associated with mortality ranging from 15 % in patients presenting with isolated AKI to as high as to 80 % in critically ill patients [5].

Keywords

Azotemia Acute tubular necrosis Diuretics Renal replacement therapies 

References

  1. 1.
    Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365–70.CrossRefPubMedGoogle Scholar
  2. 2.
    Waikar SS, Liu KD, Chertow GM. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol. 2008;3(3):844–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73(5):538–46.CrossRefGoogle Scholar
  4. 4.
    Srisawat N, Kellum JA. Acute kidney injury: definition, epidemiology, and outcome. Curr Opin Crit Care. 2011;17(6):548–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50(3):811–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Cruz DN, Bolgan I, Perazella MA, et al. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE criteria. Clin J Am Soc Nephrol. 2007;2(3):418–25.CrossRefPubMedGoogle Scholar
  7. 7.
    Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ostermann M. Acute kidney injury on admission to the intensive care unit: where to go from here? Crit Care. 2008;12(6):189.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committe. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23(5):1569–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Alobaidi R, Basu RK, Goldstein SL, Bagshaw SM. Sepsis-associated acute kidney injury. Semin Nephrol. 2015;35(1):2–11.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kellum JA, Lameire N, Group KAGW. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care. 2013;17(1):204.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kellum JA, Sileanu FE, Murugan R, Lucko N, Shaw AD, Clermont G. Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol. 2015;26(9):2231–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Brunkhorst FM, Schortgen F. Effects of hydroxyethyl starch in critically ill patients. Br J Anaesth. 2007;98(6):842–3; author reply 3–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012;367(2):124–34.CrossRefPubMedGoogle Scholar
  16. 16.
    McGillicuddy EA, Schuster KM, Kaplan LJ, et al. Contrast-induced nephropathy in elderly trauma patients. J Trauma. 2010;68(2):294–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Luciano RL. Acute kidney injury from cherry concentrate in a patient with CKD. Am J Kidney Dis. 2014;63(3):503–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Libetta C, Esposito P, Sepe V, et al. Acute kidney injury: effect of hemodialysis membrane on Hgf and recovery of renal function. Clin Biochem. 2013;46(1–2):103–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Kaplan LJ, Cheung NH, Maerz L, et al. A physicochemical approach to acid-base balance in critically ill trauma patients minimizes errors and reduces inappropriate plasma volume expansion. J Trauma. 2009;66(4):1045–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Doty JM, Saggi BH, Sugerman HJ, et al. Effect of increased renal venous pressure on renal function. J Trauma. 1999;47(6):1000–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Gong G, Wang P, Ding W, Zhao Y, Li J, Zhu Y. A modified model of the abdominal compartment syndrome. J Trauma. 2011;70(4):775–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Crouser ED. Mitochondrial dysfunction in septic shock and multiple organ dysfunction syndrome. Mitochondrion. 2004;4(5–6):729–41.CrossRefPubMedGoogle Scholar
  23. 23.
    Herrler T, Tischer A, Meyer A, et al. The intrinsic renal compartment syndrome: new perspectives in kidney transplantation. Transplantation. 2010;89(1):40–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Gomez H, Ince C, De Backer D, et al. A unified theory of sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury. Shock. 2014;41(1):3–11.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Tang D, Kang R, Coyne CB, Zeh HJ, Lotze MT. PAMPs and DAMPs: signal 0s that spur autophagy and immunity. Immunol Rev. 2012;249(1):158–75.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Langenberg C, Gobe G, Hood S, May CN, Bellomo R. Renal histopathology during experimental septic acute kidney injury and recovery. Crit Care Med. 2014;42(1):e58–67.CrossRefPubMedGoogle Scholar
  27. 27.
    Piper GL, Kaplan LJ. Fluid and electrolyte management for the surgical patient. Surg Clin North Am. 2012;92(2):189–205, vii.CrossRefPubMedGoogle Scholar
  28. 28.
    Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med. 2013;126(3):264 e9–24.CrossRefGoogle Scholar
  29. 29.
    Kasotakis G, Sideris A, Yang Y, et al. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database. J Trauma Acute Care Surg. 2013;74(5):1215–21; discussion 21–2.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Yates DR, Davies SJ, Milner HE, Wilson RJ. Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery. Br J Anaesth. 2014;112(2):281–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Joseph B, Zangbar B, Pandit V, et al. The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. J Trauma Acute Care Surg. 2014;76(2):457–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Kellum JA, Cerda J, Kaplan LJ, Nadim MK, Palevsky PM. Fluids for prevention and management of acute kidney injury. Int J Artif Organs. 2008;31(2):96–110.CrossRefPubMedGoogle Scholar
  33. 33.
    Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308(15):1566–72.CrossRefGoogle Scholar
  34. 34.
    Prowle JR, Bellomo R. Fluid administration and the kidney. Curr Opin Crit Care. 2013;19(4):308–14.CrossRefPubMedGoogle Scholar
  35. 35.
    Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD. Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Br J Surg. 2015;102(1):24–36.CrossRefGoogle Scholar
  36. 36.
    Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247–56.CrossRefPubMedGoogle Scholar
  37. 37.
    Perel P, Roberts I, Pearson M. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2007;4.Google Scholar
  38. 38.
    Schortgen F, Lacherade JC, Bruneel F, et al. Effects of hydroxyethyl starch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet. 2001;357(9260):911–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Wiedermann CJ, Dunzendorfer S, Gaioni LU, Zaraca F, Joannidis M. Hyperoncotic colloids and acute kidney injury: a meta-analysis of randomized trials. Crit Care. 2010;14(5):R191.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.CrossRefPubMedGoogle Scholar
  41. 41.
    Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301–11.CrossRefPubMedGoogle Scholar
  42. 42.
    ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371(16):1496–506.CrossRefGoogle Scholar
  43. 43.
    Pro CI, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683–93.CrossRefGoogle Scholar
  44. 44.
    Mehta RL, Pascual MT, Soroko S, Chertow GM. Diuretics, mortality and nonrecovery of renal function in acute renal failure. JAMA. 2002;288(20):2547–53.CrossRefPubMedGoogle Scholar
  45. 45.
    Ho KM, Power BM. Benefits and risks of furosemide in acute kidney injury. Anaesthesia. 2010;65(3):283–93.CrossRefPubMedGoogle Scholar
  46. 46.
    Ho KM, Sheridan DJ. Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ. 2006;333(7565):420.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Friedrich JO, Adhikari N, Herridge MS, Beyene J. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med. 2005;142(7):510–24.CrossRefPubMedGoogle Scholar
  48. 48.
    Landoni G, Biondi-Zoccai GG, Tumlin JA, et al. Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials. Am J Kidney Dis. 2007;49(1):56–68.CrossRefPubMedGoogle Scholar
  49. 49.
    Allgren RL, Marbury TC, Rahman SN, et al. Anaritide in acute tubular necrosis. Auriculin Anaritide Acute Renal Failure Study Group. N Engl J Med. 1997;336(12):828–34.CrossRefPubMedGoogle Scholar
  50. 50.
    Lewis J, Salem MM, Chertow GM, et al. Atrial natriuretic factor in oliguric acute renal failure. Anaritide Acute Renal Failure Study Group. Am J Kidney Dis. 2000;36(4):767–74.CrossRefPubMedGoogle Scholar
  51. 51.
    Nigwekar SU, Navaneethan SD, Parikh CR, Hix JK. Atrial natriuretic peptide for management of acute kidney injury: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(2):261–72.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Macias WL, Alaka KJ, Murphy MH, Miller ME, Clark WR, Mueller BA. Impact of the nutritional regimen on protein catabolism and nitrogen balance in patients with acute renal failure. JPEN J Parenter Enteral Nutr. 1996;20(1):56–62.CrossRefPubMedGoogle Scholar
  53. 53.
    McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277–316.CrossRefPubMedGoogle Scholar
  54. 54.
    Mueller C, Compher C, Ellen DM. American Society for P, Enteral Nutrition Board of D. A.S.P.E.N. Clinical guidelines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr. 2011;35(1):16–24.CrossRefPubMedGoogle Scholar
  55. 55.
    Pannu N, James M, Hemmelgarn B, Klarenbach S, Alberta Kidney Disease Network. Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol. 2013;8(2):194–202.CrossRefPubMedGoogle Scholar
  56. 56.
    Heung M, Faubel S, Watnick S, et al. Outpatient dialysis for patients with AKI: a policy approach to improving care. Clin J Am Soc Nephrol. 2015;10(10):1868–74.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney inter Suppl. 2012;2:1–138.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

<SimplePara><Emphasis Type="Bold">Open Access</Emphasis> This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (http://creativecommons.org/licenses/by-nc/2.5/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. </SimplePara> <SimplePara>The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.</SimplePara>

Authors and Affiliations

  1. 1.Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Department of MedicineFoothills Medical CenterCalgaryCanada

Personalised recommendations