Overview of the management of acute kidney injury (acute renal failure)
- Mark D Okusa, MD
Mark D Okusa, MD
- Professor of Medicine
- University of Virginia Health System
- Mitchell H Rosner, MD
Mitchell H Rosner, MD
- Professor of Medicine
- University of Virginia Health System
Acute renal failure (ARF) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). This results in an elevation of serum blood urea nitrogen (BUN), creatinine, and other metabolic waste products that are normally excreted by the kidney.
The term acute kidney injury (AKI), rather than ARF, is increasingly used by the nephrology community to refer to the acute loss of kidney function. This term also highlights that injury to the kidney that does not result in "failure" is also of great clinical significance. In this topic review, the acute loss of kidney function will be referred to as AKI.
The initial assessment of patients with AKI and management of the major complications of AKI are discussed here. The incidence, causes, diagnosis, and prevention of AKI are presented separately. (See "Diagnostic approach to the patient with subacute kidney injury in an outpatient setting" and "Renal and patient outcomes after acute tubular necrosis" and "Possible prevention and therapy of postischemic (ischemic) acute tubular necrosis".)
AKI has multiple possible etiologies. Among hospitalized patients, AKI is most commonly due to acute tubular necrosis (ATN) from ischemia, nephrotoxin exposure, or sepsis . The pathogenesis of ATN is discussed elsewhere. (See "Pathogenesis and etiology of postischemic (ischemic) acute tubular necrosis" and "Pathogenesis, clinical features, and diagnosis of contrast-induced nephropathy".)
Other frequent causes of AKI among either ambulatory or hospitalized patients include volume depletion, urinary obstruction, rapidly progressive glomerulonephritis, and acute interstitial nephritis. The pathogeneses of these disorders are also discussed elsewhere. (See "Etiology and diagnosis of prerenal disease and acute tubular necrosis in acute kidney injury (acute renal failure)" and "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis" and "Overview of the classification and treatment of rapidly progressive (crescentic) glomerulonephritis" and "Clinical manifestations and diagnosis of acute interstitial nephritis".)
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- INITIAL EVALUATION AFTER DIAGNOSIS
- Immediate therapy
- Volume issues
- - Volume depletion
- - Volume overload
- Metabolic acidosis
- Bleeding disorders
- Indications for dialysis therapy
- SUMMARY AND RECOMMENDATIONS