Acute Kidney Injury โ Diagnosis and Treatment
Diagnosis
Doctors use several tests to check kidney function and find the cause of acute kidney injury (AKI). They often start by measuring serum creatinine and blood urea nitrogen (BUN) levels.
A fast increase in these markers shows kidney filtration problems. Health professionals watch urine output closely; a drop (oliguria) may mean AKI is getting worse.
Urinalysis checks for blood, protein, or other changes. This test can help find glomerulonephritis, interstitial nephritis, or hematuria.
Doctors may order imaging, like renal ultrasound or CT scans. These tests can show blockages, hydronephrosis, or other injuries.
Sometimes, doctors use a biopsy for more information, especially if they suspect vasculitis or glomerular diseases. They also use blood counts and volume checks to look for shock, sepsis, or chronic kidney disease.
By reviewing recent exposure to harmful drugs and checking for illnesses, doctors can find causes and risks for kidney problems.
Treatment
Managing the Underlying Reason for Kidney Problems
The first step is to find and treat what is making the kidneys work poorly. Medical teams check if a medication, infection, low blood flow, or injury is the cause.
They may stop or adjust medicines that could harm the kidneys, like some antibiotics or blood pressure drugs. If heart failure or blood loss is the problem, doctors improve heart function or give fluids to help the kidneys.
Clinicians use lab tests, exams, and patient history to guide care. If an infection or another illness is linked to the kidney problem, treating that illness comes first.
This approach helps restore normal blood flow to the kidneys and prevents more damage.
Common actions to address the cause include:
| Cause of AKI | Possible Actions |
|---|---|
| Medication toxicity | Hold or stop the medicine |
| Dehydration (hypovolemia) | Give IV fluids (fluid resuscitation) |
| Heart failure | Improve heart function, balance fluids |
| Infection | Treat infection with proper medicine |
Supporting the Body Until the Kidneys Recover
Doctors work to prevent or manage problems during recovery. Damaged kidneys can cause trouble with fluid balance, electrolytes like potassium and calcium, and acid levels in the blood.
Approaches to support recovery:
Balancing Body Fluids: If the patient has too little fluid (hypovolemia), IV fluids help. If there is too much fluid (fluid overload), diuretics help remove extra water and reduce swelling.
Managing Potassium and Other Electrolytes: When potassium is too high (hyperkalemia), doctors use potassium binders like sodium zirconium cyclosilicate. If calcium is low, patients may get IV calcium.
Treating Acid-Base Imbalance: Some patients get acidosis from waste buildup. Sodium bicarbonate, by mouth or IV, helps raise blood pH and restore balance.
Start Renal Replacement Therapy if Needed: If waste, potassium, or swelling becomes severe, or if there is ongoing pericarditis, doctors may start dialysis. Dialysis uses a machine to filter waste, remove fluid, and balance electrolytes when the kidneys canโt.
Key complications to monitor and manage:
- Fluid overload
- Hyperkalemia
- Low calcium levels
- Acidosis
- Hypertension
Doctors use regular blood tests, watch urine output, and adjust fluids to help patients recover.
Everyday Habits and Home Care
Changing daily habits can help people recover from acute kidney injury. Eating the right foods and managing symptoms protects the kidneys and supports health.
Tips for managing your diet:
- Pick Foods with Less Potassium: Choose apples, peaches, carrots, green beans, white bread, and white rice. Avoid high-potassium foods like bananas, potatoes, and nuts to keep potassium levels safe.
- Avoid Salty Foods: Limit foods with added salt. This means eating fewer frozen dinners, canned soups, fast food, salty snacks, processed meats, and canned vegetables or cheeses.
- Reduce Phosphorus: Cut back on foods high in phosphorus, such as dark sodas, milk, bran cereals, and oatmeal. Too much phosphorus can cause itchy skin and weak bones.
Managing Symptoms:
| Symptom | How to Help |
|---|---|
| Nausea | Eat small meals and drink fluids slowly. |
| Confusion | Keep hydration steady and follow the care plan. |
| Dehydration | Drink water as recommended by your medical team. |
People with diabetes should keep their blood sugar in the target range to help the kidneys heal.
Getting Ready for Your Medical Visit
Before seeing a healthcare provider about possible kidney issues, it helps to be prepared. Bring a list of your symptoms, recent medical events like major surgery, or other health problems.
Write down any medicines, vitamins, or supplements you take.
Questions to consider asking:
- What is the likely reason for my symptoms?
- Do you think my kidneys are not working? What may have caused this?
- What tests will I need?
- What are my options for treatment, and what are their risks?
- Do I need to be admitted to the hospital?
- Can my kidneys get better, or will I need dialysis?
- How do I manage my other health conditions with this problem?
- Should I follow a special diet? Can I talk to a dietitian?
Tip: If you have a scheduled surgery, ask how it could affect your kidneys and if you need extra care before or after the procedure. Bring a notebook to write down answers and directions from your healthcare provider.
Managing Life with Sudden Kidney Injury
Talking About Kidney Transplant Options
People with acute kidney problems want to know about their long-term outlook and next steps.
Discussing transplants is important, especially for those who have had kidney failure or risk end-stage kidney disease. Here are key points people talk about:
| Topic | Why it Matters |
|---|---|
| Eligibility | Not everyone can have a transplant. |
| Outcomes and Prognosis | Transplants can improve quality of life, but there are risks. |
| Hospitalization | Recovery can take time and may include ICU care. |
| Mortality Risks | Acute kidney injury raises health risks, including mortality and morbidity. |
