Acute Kidney Injury

Abstract

Acute kidney injury (AKI) is defined as the sudden loss of kidney function. AKI is part of a group of diseases collectively called acute kidney disease and disorder (AKD), in which a slow decline in kidney function or persistent kidney dysfunction is associated with irreversible loss of nephrons (functional units of kidney), which can eventually lead to chronic kidney disease (CKD). New biomarkers to detect injury before loss of function await clinical application. AKI and AKD is a major concern worldwide. Infections and hypovolemic shock are the main causes of AKI in low- and middle-income countries. In high-income countries, AKI occurs most often in hospitalized elderly patients and is associated with sepsis, medications, or invasive procedures. Infections and trauma-induced AKI are common in all regions. The broad spectrum of AKI involves different pathophysiological mechanisms. Management of AKI in the intensive care setting is complex, including appropriate volume management, careful monitoring of nephrotoxic drugs, and choice of renal replacement therapies. Fluid and electrolyte management is essential. Because AKI can be fatal, renal replacement therapy is often necessary. AKI generally has a poorer prognosis in critically ill patients due to various reasons. Long-term consequences of AKI and AKD include chronic kidney disease and morbidity due to cardiovascular disease. Therefore, early detection and prevention of AKI are quintessential.