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Acute Kidney Injury and Chronic Kidney Disease

Understanding AKI (Acute Kidney Injury) and CKD (Chronic Kidney Disease)

Symptoms of Kidney Disease and Prevention Strategies

Signs and Symptoms

  • Decreased urine output
  • Swelling in legs, ankles, or feet
  • Shortness of breath
  • Fatigue and confusion (severe cases)
  • Nausea and vomiting (severe cases)

Prevention Strategies

  • Stay well hydrated, especially when sick
  • Be cautious with medications that can affect your kidneys (i.e. NSAIDs)
  • Manage diabetes and blood pressure
  • Tell doctors about kidney problems before procedures
  • Follow up with kidney specialist if recommended
What is Acute Kidney Injury?
Acute Kidney Injury (AKI) is a sudden decrease in kidney function that happens over hours or days. Your kidneys are unable to filter waste and excess fluid from your blood properly.

Common Causes:

  • Dehydration or blood loss
  • Heart failure
  • Severe infection (sepsis)
  • Shock
  • Certain medications
  • Obstructive causes such as urinary retention

Treatment of AKI

  • Fluid management
  • Medication review (renal dosing and avoidance of nephrotoxic medications)
  • Insertion of a catheter to drain the bladder if retaining urine
  • Close monitoring of urine output, urine studies, daily labs
  • Treatment of underlying causes
  • Nutrition support: Proper protein intake
  • Electrolyte balance: Management of sodium, potassium, and phosphorus
  • Blood pressure control
  • Dialysis: If severe kidney failure
What is Chronic Kidney Disease?
CKD or Chronic Kidney Disease is a long term condition that occurs when there is damage to the kidneys and they lose the ability to remove toxins and fluid from the blood.

Causes of CKD

  • High Blood Pressure
  • Diabetes
  • Heart Disease or Heart Failure
  • Cirrhosis
  • Personal history of AKI
  • Family history of CKD
  • Nephrotoxic Agents
  • Glomerular Diseases (glomeruli are the tiny filtering units inside the kidneys)
  • Polycystic Kidney Disease
  • Autoimmune Diseases (i.e. Lupus)

Risk Factors for Progression of CKD

  • Decreased renal perfusion (blood flow to kidneys) which can occur with dehydration or with conditions like congestive heart failureNephrotoxins such as NSAIDs (ibuprofen, naproxen) which block the auto-regulatory mechanisms of the kidney that preserve GFR
  • Uncontrolled hypertension (BP goal <140/90)
  • UTI or urinary obstruction/retention
  • Stenosis (narrowing) of renal artery
  • Thrombosis (clot) of renal vein

Stages of CKD

Staging is based on GFR (estimated glomerular filtration rate which indicates how well the kidneys can filter toxins)

  • Stage 1: GFR normal or high (90 or higher) and accompanying structural defect (such as protein in urine)
  • Stage 2: GFR mildly decreased (60-89) and accompanying structural defect
  • Stage 3a: GFR 45-59
  • Stage 3b: GFR 30-44
  • Stage 4: GFR 15-29
  • Stage 5: GFR<15

Treatment of CKD

Goal of treatment is to slow progression of CKD and manage complications

  • Avoidance of risk factors (listed above)
  • Sodium restriction (<3 grams/day)
  • Potassium restriction (<60 mEq/day) - avoid tomato based products, bananas, potatoes and citrus drinks
  • Phosphate restriction (<800-1000 mg/day) - avoid dairy products, dark colas, nuts
  • Treat underlying cause (blood pressure and blood sugar control)
  • Management of cholesterol
  • Diuretics for fluid retention
  • Erythropoietin (to stimulate red blood cell production) for management of anemia
  • Management of bone mineral disorders (via vitamin D and calcium supplementation as well as oral phosphate binders if phosphate levels are high)
  • Sodium bicarbonate supplementation (due to inability of kidneys to excrete acid)
  • If end stage kidney disease, initiation of dialysis