To discuss Acute Kidney Injury in terms of its

a. Epidemiology, Etiology, and Pathophysiology

b. Diagnostic evaluation
c. Treatment and Complications

DEFINITION

Harrison’s 20th Edition

 AKI is defined by the impairment of kidney filtration and excretory function over days to weeks,
resulting in the retention of nitrogenous and other waste products normally cleared by the
kidneys. is not a single disease but, rather, a designation for a heterogeneous group of
conditions that share common diagnostic features: specifically, an increase in serum creatinine
(SCr) concentration often associated with a reduction in urine volume.

KDIGO 2012
 AKI is defined as any of the following (Not Graded):
o Increase in SCr by ≥0.3 mg/dl (≥26.5 lmol/l) within 48 hours; or
o Increase in SCr to ≥1.5 times baseline, which is known or presumed to have occurred
within the prior 7 days; or
o Urine volume <0.5 ml/kg/h for 6 hours.

EPIDEMIOLOGY
 AKI complicates 5–7% of acute care hospital admissions and up to 30% of admissions to the
intensive care unit. AKI is associated with a markedly increased risk of death in hospitalized
individuals, particularly in those admitted to the ICU where in-hospital mortality rates may
exceed 50%. AKI increases the risk for the development or worsening of chronic kidney disease
(CKD).

ETIOLOGY AND PATHOPHYSIOLOGY

The causes of AKI have traditionally been divided into three broad categories: prerenal azotemia,
intrinsic renal parenchymal disease, and postrenal obstruction.
DIAGNOSTIC EVALUATION
 RIFLE Criteria
o The Acute Dialysis Quality Initiative (ADQI) group developed a system for diagnosis and
classification of a broad range of acute impairment of kidney function through a broad consensus
of experts.
o The acronym RIFLE stands for the increasing severity classes Risk, Injury, and Failure; and the
two outcome classes, Loss and End-Stage Renal Disease (ESRD). The three severity grades are
defined on the basis of the changes in SCr or urine output where the worst of each criterion is
used. The two outcome criteria, Loss and ESRD, are defined by the duration of loss of kidney
function.
TREATMENT

COMPLICATIONS
The kidney plays a central role in homeostatic control of volume status, blood pressure, plasma
electrolyte composition, and acid-base balance, and for excretion of nitrogenous and other waste
products. Complications associated with AKI are, therefore, protean, and depend on the severity of AKI
and other associated conditions. Mild to moderate AKI may be entirely asymptomatic, particularly early
in the course.

1. Uremia
2. Hypervolemia and Hypovolemia
3. Hyponatremia
4. Hyperkalemia
5. Acidosis
6. Hyperphosphatemia and Hypocalcemia
7. Bleeding
8. Infections
9. Cardiac complications
10. Malnutrition