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Acute kidney injury: Difference between revisions

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Acute kidney injury (view source)

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* Is there a renoparenchymal disease?
* Is there a renoparenchymal disease?


Patient history, physical examination, previous [[kidney function tests]], and [[ultrasound]] can help answer these questions. An AKI kidney has normal macroscopic morphology, as opposed to a CKD kidney. A renal cause usually has abnormal [[urine analysis]], with proteinuria, increased urinary sodium, or decreased urinary osmolality. A postrenal cause can have a palpable bladder, or obstruction or hydronephrosis can be visible on [[ultrasonography]]. Allergic symptoms can suggest nephritis. Low BP can suggest hypovolaemia.
Patient history, physical examination, previous [[kidney function tests]], and [[ultrasound]] can help answer these questions. An AKI kidney has normal macroscopic morphology (as seen with radiologic imaging), as opposed to a CKD kidney, which is usually shorter than normal and has a thinner cortex. A renal cause usually has abnormal [[urine analysis]], with proteinuria, increased urinary sodium, or decreased urinary osmolality, as well as the presence of epithelial casts or brown granular casts in the urine. A postrenal cause can have a palpable bladder, or obstruction or hydronephrosis can be visible on [[ultrasonography]]. Allergic symptoms can suggest nephritis. Low BP can suggest hypovolaemia.


<section begin="radiology" />In case of AKI, the kidney is usually enlarged, which can be visualised on ultrasonography. Ultrasound may also reveal an underlying cause and is therefore usually the first choice imaging modality for AKI.
<section begin="radiology" />In case of AKI, the kidney is usually enlarged, which can be visualised on ultrasonography. Ultrasound may also reveal an underlying cause and is therefore usually the first choice imaging modality for AKI.


<section end="radiology" /><section begin="clinical biochemistry" />The urea:creatinine ratio may be useful in finding the cause. A high ratio (> 20:1) suggests a prerenal cause, while a lower ratio (< 20:1) suggests a renal cause.<section end="clinical biochemistry" />
<section end="radiology" /><section begin="clinical biochemistry" />Previously it was suggested that the urea:creatinine ratio was useful in distinguishing between prerenal and intrinsic AKI, but a study designed to investigate this found that the ratio can not distinguish them<ref>https://pubmed.ncbi.nlm.nih.gov/28545421/</ref>.<section end="clinical biochemistry" />


If the cause remains unclear despite these investigations, a [[renal biopsy]] may be required.
If the cause remains unclear despite these investigations, a [[renal biopsy]] may be required.
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== Prognosis ==
== Prognosis ==
In many cases patients make a full recovery, but AKI can progress to chronic kidney disease as well. It might take months for kidney functions to recover completely, during which the patient may experience [[polyuria]] because the tubules need a long time to recover.
In many cases patients make a full recovery, but AKI can progress to chronic kidney disease as well. It might take months for kidney functions to recover completely, during which the patient may experience [[polyuria]] because the tubules need a long time to recover.
== References ==
[[Category:Nephrology]]
[[Category:Nephrology]]