Materiały źródłowe

• #1 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  Acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. The diagnostic evaluation can be used to classify acute kidney injury as prerenal, intrinsic renal, or postrenal. The initial workup includes a patient history to identify the use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. The initial laboratory evaluation should include measurement of serum creatinine level, complete blood count, urinalysis, and fractional excretion of sodium. Ultrasonography of the kidneys should be performed in most patients, particularly in older men, to rule out obstruction. […] The diagnosis of acute kidney injury is based on serum creatinine levels, urine output, and the need for renal replacement therapy.

• #2 Acute Kidney Injury (AKI) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/acute-kidney-injury

  Acute kidney injury can be difficult to detect unless the doctor is trained to look for it, says Yale Medicine nephrologist F. Perry Wilson, MD. This is because there are rarely any symptoms until kidney function is severely damaged. […] Doctors diagnose acute kidney injury by measuring the level of creatinine in the blood. (Creatinine is a chemical waste product removed by the body entirely by the kidneys. If the kidneys are not working properly, there will be an increase in levels in the blood.) […] When a patient shows sudden high levels of creatinine in the blood, it is likely that the patient is experiencing acute kidney injury. Doctors will use clinical context to rule out other similar conditions, such as chronic kidney disease. […] Once AKI is diagnosed, doctors will try to find the underlying cause in order to treat it. Sometimes, the underlying cause is easily identifiable because it correlates with another major condition that may have led to blood loss or infection (such as pneumonia with septic shock, cardiac surgery, trauma with hemorrhagic shock, and diarrhea).

• #3 Diagnostic Criteria for Acute Kidney Injury: Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4584412/

  Acute kidney injury in a clinical diagnosis guided by standard criteria based on changes in serum creatinine, urine output or both. Severity of acute kidney injury is determined by the magnitude of increase in serum creatinine or decrease in urine output. Patients manifesting both oliguria and azotemia and those in which these impairments are persistent are more likely to have worse disease and worse outcomes. […] Minimum criteria for Acute Kidney Injury include an Increase in SCr by 0.3 mg/dl (26.5 mol/l) observed within 48 hours; or an Increase in SCr to 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or Urine volume 0.5 ml/kg/h for 6 hours. […] The criteria for acute kidney are based on changes in serum creatinine and urine output. Standardized criteria such as KDIGO criteria allow for uniform implementation of guidelines and reliable estimates of incidence and outcomes.

• #4 Acute Kidney Injury (AKI): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/243492-overview

  Acute kidney injury (AKI) is a clinical syndrome manifested by a rapid or abrupt decline in kidney function and subsequent dysregulation of the body electrolytes and volume, and abnormal retention of nitrogenous waste. AKI was formerly known as acute renal failure. AKI is a complex condition with a wide range of causes, including ischemic injury and exposure to nephrotoxic agents. […] The widely accepted Kidney Disease: Improving Global Outcome (KDIGO) definition of AKI is based on the change of serum creatinine and urine output, as follows: Rise in serum creatinine 0.3 mg/dL within 48 hours; Rise in serum creatinine 1.5 times baseline, which is known or presumed to have occurred within the prior seven days; Urine output 0.5 mL/kg/hour for six hours. […] Most patients with AKI have no clinical symptoms related to AKI and are diagnosed on the basis of a routine laboratory blood test. Depending on the degree and duration of kidney function impairment, however, they might have hypertension, edema, decreased urine output, shortness of breath, anorexia, nausea, sleep disturbances, and altered mental status.

• #5 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  The serum creatinine level, which is part of the diagnostic criteria for acute kidney injury, is easily obtained. However, it is not an ideal marker, because creatinine concentration is influenced by age, sex, race, muscle mass, and protein catabolic rate. Additionally, serum creatinine is a slow changing surrogate for decreased GFR and may take 24 to 72 hours to reach a new steady state following acute kidney injury. […] Urine output can be difficult to accurately assess because of collection and documentation errors. Serum creatinine or urine output can be used for diagnosis of acute kidney injury, although patients who meet diagnostic criteria for both are at increased risk of mortality from renal replacement therapy and hospitalization. […] Creatinine clearance is a direct measure of GFR, and serial creatinine clearance testing provides a more efficient and accurate assessment of renal function than serum creatinine testing.

• #6 Acute Kidney Injury (AKI) – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

  Acute kidney injury is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood (azotemia) with or without reduction in amount of urine output. […] Diagnosis is based on laboratory tests of renal function, including serum creatinine. Urinary indices, urinary sediment examination, and often imaging and other tests (including sometimes a kidney biopsy) are needed to determine the cause. […] Acute kidney injury (AKI) is suspected when urine output falls or serum blood urea nitrogen (BUN) and creatinine rise. […] Per the KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for Acute Kidney Injury (1), AKI is defined as any of the following: Increase in the serum creatinine value of 0.3 mg/dL (26.52 micromol/L) in 48 hours; Increase in serum creatinine of 1.5 times baseline within the prior 7 days; Urine volume 0.5 mL/kg/hour for 6 hours.

• #7 Diagnostic Criteria for Acute Kidney Injury: Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4584412/

  Acute kidney injury in a clinical diagnosis guided by standard criteria based on changes in serum creatinine, urine output or both. Severity of acute kidney injury is determined by the magnitude of increase in serum creatinine or decrease in urine output. Patients manifesting both oliguria and azotemia and those in which these impairments are persistent are more likely to have worse disease and worse outcomes. […] Minimum criteria for Acute Kidney Injury include an Increase in SCr by 0.3 mg/dl (26.5 mol/l) observed within 48 hours; or an Increase in SCr to 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or Urine volume 0.5 ml/kg/h for 6 hours. […] The criteria for acute kidney are based on changes in serum creatinine and urine output. Standardized criteria such as KDIGO criteria allow for uniform implementation of guidelines and reliable estimates of incidence and outcomes.

• #8 Diagnostic Criteria for Acute Kidney Injury: Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4584412/

  However, acute kidney injury (AKI) remains a clinical diagnosis and clinical judgment is necessary to apply diagnostic criteria and to evaluate the changing clinical status of the patient. […] Both serum creatinine and urine output provide independent and complementary information on renal function. Novel biomarkers can provide information on kidney damage and the latest markers can assess kidney stress.

• #9 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  A patient history and physical examination, with an emphasis on assessing the patients volume status, are crucial for determining the cause of acute kidney injury. The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness. The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium (FENa). Imaging studies can help rule out obstruction. […] Renal ultrasonography should be performed in most patients with acute kidney injury, particularly in older men, to rule out obstruction (i.e., a postrenal cause). The presence of postvoid residual urine greater than 100 mL suggests postrenal acute kidney injury and requires renal ultrasonography to detect hydronephrosis or outlet obstruction. […] Renal biopsy is reserved for patients in whom prerenal and postrenal causes of acute kidney injury have been excluded and the cause of intrinsic renal injury is unclear.

• #10 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. Acute kidney injury is associated with an increased risk of mortality, cardiovascular events, and progression to chronic kidney disease. Severity of acute kidney injury is classified according to urine output and elevations in creatinine level. Accurate diagnosis of the underlying cause is key to successful management and includes a focused history and physical examination, serum and urine electrolyte measurements, and renal ultrasonography when risk factors for a postrenal cause are present (e.g., older male with prostatic hypertrophy). […] The history and physical examination are important in determining the etiology of acute kidney injury. The history can identify nephrotoxic medications or a systemic illness contributing to impaired renal function. The physical examination should focus on evaluating intravascular volume status. Skin rashes may indicate an underlying condition (e.g., systemic lupus erythematosus, atheroembolism/vasculitis) or exposure (e.g., drug rash suggesting acute interstitial necrosis) leading to acute kidney injury.

• #11 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  A patient history and physical examination, with an emphasis on assessing the patients volume status, are crucial for determining the cause of acute kidney injury. The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness. The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium (FENa). Imaging studies can help rule out obstruction. […] Renal ultrasonography should be performed in most patients with acute kidney injury, particularly in older men, to rule out obstruction (i.e., a postrenal cause). The presence of postvoid residual urine greater than 100 mL suggests postrenal acute kidney injury and requires renal ultrasonography to detect hydronephrosis or outlet obstruction. […] Renal biopsy is reserved for patients in whom prerenal and postrenal causes of acute kidney injury have been excluded and the cause of intrinsic renal injury is unclear.

• #12 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. Acute kidney injury is associated with an increased risk of mortality, cardiovascular events, and progression to chronic kidney disease. Severity of acute kidney injury is classified according to urine output and elevations in creatinine level. Accurate diagnosis of the underlying cause is key to successful management and includes a focused history and physical examination, serum and urine electrolyte measurements, and renal ultrasonography when risk factors for a postrenal cause are present (e.g., older male with prostatic hypertrophy). […] The history and physical examination are important in determining the etiology of acute kidney injury. The history can identify nephrotoxic medications or a systemic illness contributing to impaired renal function. The physical examination should focus on evaluating intravascular volume status. Skin rashes may indicate an underlying condition (e.g., systemic lupus erythematosus, atheroembolism/vasculitis) or exposure (e.g., drug rash suggesting acute interstitial necrosis) leading to acute kidney injury.

• #13 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  A patient history and physical examination, with an emphasis on assessing the patients volume status, are crucial for determining the cause of acute kidney injury. The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness. The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium (FENa). Imaging studies can help rule out obstruction. […] Renal ultrasonography should be performed in most patients with acute kidney injury, particularly in older men, to rule out obstruction (i.e., a postrenal cause). The presence of postvoid residual urine greater than 100 mL suggests postrenal acute kidney injury and requires renal ultrasonography to detect hydronephrosis or outlet obstruction. […] Renal biopsy is reserved for patients in whom prerenal and postrenal causes of acute kidney injury have been excluded and the cause of intrinsic renal injury is unclear.

• #14 Acute kidney injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-failure/diagnosis-treatment/drc-20369053

  During a kidney biopsy, a healthcare professional uses a needle to remove a small sample of kidney tissue for lab testing. The biopsy needle is put through the skin to the kidney. The procedure often uses an imaging device, such as an ultrasound transducer, to guide the needle. […] You might have the following tests to diagnose acute kidney injury: […] A sample of your blood may show fast-rising levels of urea and creatinine. This helps show how your kidneys are working. […] Measuring how much urine you pass in 24 hours may help find the cause of your kidney failure. […] A sample of your urine may show something that suggests a condition that might explain kidney failure. This is called urinalysis. […] Imaging tests such as ultrasound and CT scans can show your kidneys. […] Your healthcare professional may suggest removing a small sample of your kidney tissue for lab testing. This is called a biopsy. A needle put through your skin and into your kidney removes the sample.

• #15 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  The serum creatinine level, which is part of the diagnostic criteria for acute kidney injury, is easily obtained. However, it is not an ideal marker, because creatinine concentration is influenced by age, sex, race, muscle mass, and protein catabolic rate. Additionally, serum creatinine is a slow changing surrogate for decreased GFR and may take 24 to 72 hours to reach a new steady state following acute kidney injury. […] Urine output can be difficult to accurately assess because of collection and documentation errors. Serum creatinine or urine output can be used for diagnosis of acute kidney injury, although patients who meet diagnostic criteria for both are at increased risk of mortality from renal replacement therapy and hospitalization. […] Creatinine clearance is a direct measure of GFR, and serial creatinine clearance testing provides a more efficient and accurate assessment of renal function than serum creatinine testing.

• #16 Acute Kidney Injury (AKI): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/243492-overview

  The following tests can aid in the diagnosis and assessment of AKI: Kidney function studies: Increased levels of blood urea nitrogen (BUN) and serum creatinine are the hallmarks of AKI; the ratio of BUN to creatinine can exceed 20:1 in conditions that favor the enhanced reabsorption of urea, such as volume contraction (this suggests prerenal AKI). Complete blood count: Elevated WBC can indicate infection; risk-stratify for tumor lysis syndrome in an oncologic patient; low hemoglobin can suggest acute blood loss or chronic anemia; thrombocytopenia might indicate thrombotic microangiopathy or portal hypertension. […] Serologic tests: May show evidence of systemic diseases associated with AKI, such as lupus nephritis, ANCA vasculitis, anti-GBM disease. Ultrasonography: Renal ultrasonography is helpful in evaluating existing kidney disease (kidney length, presence of cortical echogenicity or cortical thinning) and urinary obstruction. Kidney biopsy: Can be useful in identifying intrarenal causes of AKI and directing targeted therapy.

• #17 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Urinalysis in combination with urine microscopy provides insight into the location and cause of acute kidney injury. […] The fractional excretion of sodium and the fractional excretion of urea are used to identify prerenal azotemia. A fractional excretion of sodium less than 1% suggests a prerenal cause of acute kidney injury, whereas a value greater than 2% suggests an intrinsic cause. A fractional excretion of urea less than 35% suggests a prerenal cause, whereas a value greater than 50% suggests an intrinsic cause. […] Renal ultrasonography may show evidence of a postrenal cause of acute kidney injury but should be performed only when the history suggests the presence of urinary tract obstruction. Renal biopsy is reserved for patients with intrinsic acute kidney injury of unclear etiology or when diagnostic confirmation is necessary before initiating disease-specific therapy.

• #18 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Urinalysis in combination with urine microscopy provides insight into the location and cause of acute kidney injury. […] The fractional excretion of sodium and the fractional excretion of urea are used to identify prerenal azotemia. A fractional excretion of sodium less than 1% suggests a prerenal cause of acute kidney injury, whereas a value greater than 2% suggests an intrinsic cause. A fractional excretion of urea less than 35% suggests a prerenal cause, whereas a value greater than 50% suggests an intrinsic cause. […] Renal ultrasonography may show evidence of a postrenal cause of acute kidney injury but should be performed only when the history suggests the presence of urinary tract obstruction. Renal biopsy is reserved for patients with intrinsic acute kidney injury of unclear etiology or when diagnostic confirmation is necessary before initiating disease-specific therapy.

• #19 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Urinalysis in combination with urine microscopy provides insight into the location and cause of acute kidney injury. […] The fractional excretion of sodium and the fractional excretion of urea are used to identify prerenal azotemia. A fractional excretion of sodium less than 1% suggests a prerenal cause of acute kidney injury, whereas a value greater than 2% suggests an intrinsic cause. A fractional excretion of urea less than 35% suggests a prerenal cause, whereas a value greater than 50% suggests an intrinsic cause. […] Renal ultrasonography may show evidence of a postrenal cause of acute kidney injury but should be performed only when the history suggests the presence of urinary tract obstruction. Renal biopsy is reserved for patients with intrinsic acute kidney injury of unclear etiology or when diagnostic confirmation is necessary before initiating disease-specific therapy.

• #20 Acute Kidney Injury (AKI): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/243492-overview

  The following tests can aid in the diagnosis and assessment of AKI: Kidney function studies: Increased levels of blood urea nitrogen (BUN) and serum creatinine are the hallmarks of AKI; the ratio of BUN to creatinine can exceed 20:1 in conditions that favor the enhanced reabsorption of urea, such as volume contraction (this suggests prerenal AKI). Complete blood count: Elevated WBC can indicate infection; risk-stratify for tumor lysis syndrome in an oncologic patient; low hemoglobin can suggest acute blood loss or chronic anemia; thrombocytopenia might indicate thrombotic microangiopathy or portal hypertension. […] Serologic tests: May show evidence of systemic diseases associated with AKI, such as lupus nephritis, ANCA vasculitis, anti-GBM disease. Ultrasonography: Renal ultrasonography is helpful in evaluating existing kidney disease (kidney length, presence of cortical echogenicity or cortical thinning) and urinary obstruction. Kidney biopsy: Can be useful in identifying intrarenal causes of AKI and directing targeted therapy.

• #21 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  A patient history and physical examination, with an emphasis on assessing the patients volume status, are crucial for determining the cause of acute kidney injury. The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness. The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium (FENa). Imaging studies can help rule out obstruction. […] Renal ultrasonography should be performed in most patients with acute kidney injury, particularly in older men, to rule out obstruction (i.e., a postrenal cause). The presence of postvoid residual urine greater than 100 mL suggests postrenal acute kidney injury and requires renal ultrasonography to detect hydronephrosis or outlet obstruction. […] Renal biopsy is reserved for patients in whom prerenal and postrenal causes of acute kidney injury have been excluded and the cause of intrinsic renal injury is unclear.

• #22 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  A patient history and physical examination, with an emphasis on assessing the patients volume status, are crucial for determining the cause of acute kidney injury. The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness. The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium (FENa). Imaging studies can help rule out obstruction. […] Renal ultrasonography should be performed in most patients with acute kidney injury, particularly in older men, to rule out obstruction (i.e., a postrenal cause). The presence of postvoid residual urine greater than 100 mL suggests postrenal acute kidney injury and requires renal ultrasonography to detect hydronephrosis or outlet obstruction. […] Renal biopsy is reserved for patients in whom prerenal and postrenal causes of acute kidney injury have been excluded and the cause of intrinsic renal injury is unclear.

• #23 Acute Kidney Injury (AKI): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/243492-overview

  The following tests can aid in the diagnosis and assessment of AKI: Kidney function studies: Increased levels of blood urea nitrogen (BUN) and serum creatinine are the hallmarks of AKI; the ratio of BUN to creatinine can exceed 20:1 in conditions that favor the enhanced reabsorption of urea, such as volume contraction (this suggests prerenal AKI). Complete blood count: Elevated WBC can indicate infection; risk-stratify for tumor lysis syndrome in an oncologic patient; low hemoglobin can suggest acute blood loss or chronic anemia; thrombocytopenia might indicate thrombotic microangiopathy or portal hypertension. […] Serologic tests: May show evidence of systemic diseases associated with AKI, such as lupus nephritis, ANCA vasculitis, anti-GBM disease. Ultrasonography: Renal ultrasonography is helpful in evaluating existing kidney disease (kidney length, presence of cortical echogenicity or cortical thinning) and urinary obstruction. Kidney biopsy: Can be useful in identifying intrarenal causes of AKI and directing targeted therapy.

• #24 Kidney Failure – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/kidneyfailure

  Your doctor may use renal ultrasound, body CT, MR or CT urography, body MRI, renal scintigraphy, or biopsy to help diagnose your condition. […] In order to diagnose kidney failure, your doctor may order: […] Renal ultrasound: This imaging exam uses high-frequency sound waves to view the kidneys in real time, and is often the first test obtained to examine the kidneys. […] Body CT: Computed tomography (CT) combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. This imaging exam is often used to get a broad overview for multiple causes of kidney failure. […] MR or CT urography: This procedure is used to evaluate patients with blood in the urine, to identify issues in patients with frequent urinary tract infections and follow patients with a history of urinary collecting system cancers.

• #25 Kidney Failure – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/kidneyfailure

  Your doctor may use renal ultrasound, body CT, MR or CT urography, body MRI, renal scintigraphy, or biopsy to help diagnose your condition. […] In order to diagnose kidney failure, your doctor may order: […] Renal ultrasound: This imaging exam uses high-frequency sound waves to view the kidneys in real time, and is often the first test obtained to examine the kidneys. […] Body CT: Computed tomography (CT) combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. This imaging exam is often used to get a broad overview for multiple causes of kidney failure. […] MR or CT urography: This procedure is used to evaluate patients with blood in the urine, to identify issues in patients with frequent urinary tract infections and follow patients with a history of urinary collecting system cancers.

• #26 Kidney Failure – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/kidneyfailure

  Body magnetic resonance imaging (MRI): This imaging test uses a magnetic field and radio frequency pulses to produce detailed pictures of the kidneys. […] Renal scintigraphy: During this nuclear medicine examination, the kidneys are evaluated using a radiotracer and a gamma camera. This test can provide information about both the function of the kidneys by allowing the radiologist or nuclear medicine physician to see how the kidney functions and excretes urine. […] Biopsy: This procedure involves image-guided removal of a small kidney tissue sample in order to test it for disease. Ultimately this may be required to provide a diagnosis, but there are many non-invasive imaging tests that are usually obtained first.

• #27 Kidney Failure – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/kidneyfailure

  Body magnetic resonance imaging (MRI): This imaging test uses a magnetic field and radio frequency pulses to produce detailed pictures of the kidneys. […] Renal scintigraphy: During this nuclear medicine examination, the kidneys are evaluated using a radiotracer and a gamma camera. This test can provide information about both the function of the kidneys by allowing the radiologist or nuclear medicine physician to see how the kidney functions and excretes urine. […] Biopsy: This procedure involves image-guided removal of a small kidney tissue sample in order to test it for disease. Ultimately this may be required to provide a diagnosis, but there are many non-invasive imaging tests that are usually obtained first.

• #28 Acute Kidney Injury: A Guide to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1001/p631.html

  A patient history and physical examination, with an emphasis on assessing the patients volume status, are crucial for determining the cause of acute kidney injury. The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness. The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium (FENa). Imaging studies can help rule out obstruction. […] Renal ultrasonography should be performed in most patients with acute kidney injury, particularly in older men, to rule out obstruction (i.e., a postrenal cause). The presence of postvoid residual urine greater than 100 mL suggests postrenal acute kidney injury and requires renal ultrasonography to detect hydronephrosis or outlet obstruction. […] Renal biopsy is reserved for patients in whom prerenal and postrenal causes of acute kidney injury have been excluded and the cause of intrinsic renal injury is unclear.

• #29 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Urinalysis in combination with urine microscopy provides insight into the location and cause of acute kidney injury. […] The fractional excretion of sodium and the fractional excretion of urea are used to identify prerenal azotemia. A fractional excretion of sodium less than 1% suggests a prerenal cause of acute kidney injury, whereas a value greater than 2% suggests an intrinsic cause. A fractional excretion of urea less than 35% suggests a prerenal cause, whereas a value greater than 50% suggests an intrinsic cause. […] Renal ultrasonography may show evidence of a postrenal cause of acute kidney injury but should be performed only when the history suggests the presence of urinary tract obstruction. Renal biopsy is reserved for patients with intrinsic acute kidney injury of unclear etiology or when diagnostic confirmation is necessary before initiating disease-specific therapy.

• #30 Acute kidney injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-failure/diagnosis-treatment/drc-20369053

  During a kidney biopsy, a healthcare professional uses a needle to remove a small sample of kidney tissue for lab testing. The biopsy needle is put through the skin to the kidney. The procedure often uses an imaging device, such as an ultrasound transducer, to guide the needle. […] You might have the following tests to diagnose acute kidney injury: […] A sample of your blood may show fast-rising levels of urea and creatinine. This helps show how your kidneys are working. […] Measuring how much urine you pass in 24 hours may help find the cause of your kidney failure. […] A sample of your urine may show something that suggests a condition that might explain kidney failure. This is called urinalysis. […] Imaging tests such as ultrasound and CT scans can show your kidneys. […] Your healthcare professional may suggest removing a small sample of your kidney tissue for lab testing. This is called a biopsy. A needle put through your skin and into your kidney removes the sample.

• #31 Acute Kidney Injury: Diagnostic Approaches and Controversies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5242479/

  The use of pre-admission values of sCr poses a great dilemma: how far back can a baseline value of sCr be retrieved and still be expected to be valid for the definition of AKI? […] This method has been used in many studies using RIFLE criteria to investigate the epidemiology of AKI. […] In clinical studies, this has an effect on the prevalence of AKI in severity staging cases, in the mortality that is associated with AKI in the various stages. […] The emergence of novel biomarkers might enable us to classify AKI by functional change, kidney damage, or both and such discrimination will provide information that is interpretable, and will account for the dynamic nature of AKI. […] During the last ten years new biomarkers have emerged for the diagnosis of AKI. […] A universal definition of AKI is important for its diagnosis and management. We need to find a way to incorporate in a definition of AKI, biomarkers that show direct injury together with biomarkers that currently are used for measurement of filtration function.

• #32 Diagnosis and Management of Acute Kidney Injury in the Emergency Department – Clinical Tree

  https://clinicalpub.com/diagnosis-and-management-of-acute-kidney-injury-in-the-emergency-department/

  Biomarkers of kidney damage could result of great utility in emergency room to identify in a timely manner patients with high risk to develop AKI. […] Neutrophil gelatinase-associated lipocalin (NGAL) is an independent biologic marker able to detect earlier AKI than SCr. […] The clinical use of NGAL in ED to clinical judgement in acute kidney injury diagnosis is recognized largely in the scientific community.

• #33 Acute Kidney Injury: Biomarker-Guided Diagnosis and Management

  https://www.mdpi.com/1648-9144/58/3/340

  Considering damage biomarkers together with functional biomarkers such as CysC and proenkephalin A can aid in accurately diagnosing AKI, differentiating pathophysiologic pathways, demonstrating AKI etiology, and grading AKI severity. […] The urinary markers tissue metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7), which are recently discovered inducers of G1 cell-cycle arrest and are key stress biomarkers of AKI, are considered superior to known damage biomarkers such as kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL). […] Various biomarkers can be implemented to precisely identify patients with AKI, diagnose AKI at an early stage, and perform risk stratification of patients who require dialysis or are at an increased risk of death.

• #34 Acute Kidney Injury: From Diagnosis to Prevention and Treatment Strategies

  https://www.mdpi.com/2077-0383/9/6/1704

  Recently, potential urinary and serum biomarkers of AKI have been identified, namely cystatin-C, neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-glucosaminidase (NAG), kidney injury molecule 1 (KIM-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin 18 (IL-18), liver-type fatty acid-binding protein (L-FABP), calprotectin, urine angiotensinogen (AGT), urine microRNAs, insulin-like growth factor-binding protein 7 (IGFBP7), and tissue inhibitor of metalloproteinases-2 (TIMP-2). […] The assessment of the cause of AKI must include a careful history, including medications and exposures, as well as a thorough physical examination. […] The therapeutic strategies for AKI based on the KDIGO guidelines and bundles of care are limited and mostly supportive. […] The gold-standard of AKI prevention includes identifying at-risk patients, optimizing hemodynamic and volume statuses, reviewing medication, and minimizing nephrotoxic exposure.

• #35

  https://www.alliedacademies.org/articles/acute-kidney-injury-diagnosis-prevention-and-treatment-21837.html

  Acute kidney injury (AKI) is portrayed by an intense reduction w renal function that can be multifactorial in its starting point and is related z complex pathophysiological komponentami. […] Given the effect of the visualization of AKI, it is critical to recognize in danger patients and work on preventive, demonstrative, and treatment procedures. […] The diagnosis of AKI as an expansion in the serum creatinine (SCr) level to no less than 0.3 mg/dL inside 48 h, an expansion w SCr to more than 1.5 times the pattern (which is known or ventured to have happened inside the wcześniejszych 7 dni), or a pee yield (UO) diminishing to under 0.5 mL/kg/h for 6 h. […] As of recent, potential urinary and serum biomarkers of AKI have been identified, to be specific cystatin-C, neutrophil gelatinase related lipocalin (NGAL), N-acetylglucosaminidase (NAG), kidney injury molecule 1 (KIM-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin 18 (IL- 18), liver-type unsaturated fat binding protein (L-FABP), calprotectin, urine angiotensinogen (AGT), urine microRNAs, insulin-like growth factor-binding protein 7 (IGFBP7), and tissue inhibitor of metalloproteinases-2 (TIMP-2).

• #36 Acute Kidney Injury (AKI) Workup: Approach Considerations, Kidney Function Studies, CBC, Peripheral Smear, and Serology

  https://emedicine.medscape.com/article/243492-workup

  Several laboratory tests, including the following, are useful for assessing the etiology of acute kidney injury (AKI) and can aid in proper management of the disease: […] In early AKI, a furosemide stress test can be performed to help determine the patient’s prognosis. Low urinary output after the infusion of furosemide predicts the development of stage 3 AKI. […] In 2014 the US Food and Drug Administration (FDA) approved NephroCheck, the first laboratory test to evaluate the risk of developing moderate to severe AKI in hospitalized, critically ill patients. The test identifies the presence in urine of two AKI-associated proteins: insulinlike growth factorbinding protein 7 and tissue inhibitor of metalloproteinases. […] A kidney biopsy can be useful in identifying intrarenal causes of AKI and can be justified if the results may change management (eg, initiation of immunosuppressive medications). […] In a study by Koyner et al, FST was significantly better than any urinary biomarker tested in predicting progression to stage 3 AKI (P 0.05), and was the only test that significantly predicted receipt of renal replacement therapy.

• #37 Acute Kidney Injury (AKI) Workup: Approach Considerations, Kidney Function Studies, CBC, Peripheral Smear, and Serology

  https://emedicine.medscape.com/article/243492-workup

  Several laboratory tests, including the following, are useful for assessing the etiology of acute kidney injury (AKI) and can aid in proper management of the disease: […] In early AKI, a furosemide stress test can be performed to help determine the patient’s prognosis. Low urinary output after the infusion of furosemide predicts the development of stage 3 AKI. […] In 2014 the US Food and Drug Administration (FDA) approved NephroCheck, the first laboratory test to evaluate the risk of developing moderate to severe AKI in hospitalized, critically ill patients. The test identifies the presence in urine of two AKI-associated proteins: insulinlike growth factorbinding protein 7 and tissue inhibitor of metalloproteinases. […] A kidney biopsy can be useful in identifying intrarenal causes of AKI and can be justified if the results may change management (eg, initiation of immunosuppressive medications). […] In a study by Koyner et al, FST was significantly better than any urinary biomarker tested in predicting progression to stage 3 AKI (P 0.05), and was the only test that significantly predicted receipt of renal replacement therapy.

• #38 Acute Kidney Injury (AKI): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/243492-overview

  The Acute Kidney Injury Network (AKIN) has developed specific criteria for the diagnosis of AKI. The AKIN defines AKI as abrupt (within 48 hours) reduction of kidney function, after excluding urinary obstruction and achieving adequate hydration, manifested by any 1 of the following: An absolute increase in serum creatinine of 0.3 mg/dL or greater; A percentage increase in serum creatinine of 50% or greater; Reduced urine output, defined as less than 0.5 mL/kg/h for more than 6 hours. […] The Kidney Disease: Improving Global Outcomes (KDIGO) system, which is the most recent and widely accepted classification, was developed by merging the RIFLE and AKIN classifications into a single simplified one. It offers equivalent or superior sensitivity for AKI detection and prognostic performance compared with RIFLE and AKIN. AKI is defined by any of the following: Rise in serum creatinine 0.3 mg/dL within 48 hours; Rise in serum creatinine 1.5 times baseline, which is known or presumed to have occurred within the prior seven days; Urine output 0.5 mL/kg/hour for six hours.

• #39 Acute Kidney Injury – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-kidney-injury-diagnosis-treatment/

  Acute Kidney Injury (AKI) is defined as an acute loss of kidney function, with subsequent accumulation of metabolic waste products. […] AKI is diagnosed based on serum creatinine (SCr) levels or decreased urine output. […] Baseline creatinine measurements may not be available. Patients at increased risk of AKI should have SCr and urine output monitored. […] Investigations are guided based on the likely cause (prerenal, intrarenal, postrenal). Postrenal causes CANNOT be ruled out based on urine output. […] AKI Staging criteria based on Kidney Disease: Improving Global Outcomes definitions.

• #40 Acute Kidney Injury: Diagnostic Approaches and Controversies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5242479/

  Although a number of biomarkers of functional change and cellular damage are under evaluation for early diagnosis, risk assessment and prognosis of AKI, the current definitions in use (which are consensus definitions), include only the measurement of sCr and urinary output (UO) and they are far from being ideal. […] Moreover the lack of a true gold standard in the diagnosis of AKI means that we don’t have any data on the sensitivity and specificity of a creatinine based definition of AKI. […] These definitions may have helped clinicians to establish AKI diagnosis and staging, while urine examination can help in differential diagnosis. However after many years of clinical utilisation of these definitions, several limitations have been revealed. […] We also explore the current status of established and emerging biomarkers and how they can be used to further refine the definition of AKI.

• #41 Acute Kidney Injury: Diagnostic Approaches and Controversies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5242479/

  It is important to note that the isolated use of sCr concentration may not reflect the actual degree of kidney function of a certain patient. […] Measurement of CrCl can provide adequate clinical information under steady state conditions, but has two serious limitations: the difficulty to obtain accurate urine collections and the potential misinterpretation because of the large biologic variability of creatinine metabolism in various clinical settings, including the unpredictable level of creatinine secretion at different levels of GFR. […] Current consensus definitions require small changes in sCr (26.5 mol/L or 0.3 mg/dL or 50% baseline to peak) for diagnosis of AKI. […] These associations of such small changes with adverse outcome in published studies may reveal the ability of confounders and not AKI to influence the development of CKD.

• #42 Acute Kidney Injury: Diagnostic Approaches and Controversies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5242479/

  The use of pre-admission values of sCr poses a great dilemma: how far back can a baseline value of sCr be retrieved and still be expected to be valid for the definition of AKI? […] This method has been used in many studies using RIFLE criteria to investigate the epidemiology of AKI. […] In clinical studies, this has an effect on the prevalence of AKI in severity staging cases, in the mortality that is associated with AKI in the various stages. […] The emergence of novel biomarkers might enable us to classify AKI by functional change, kidney damage, or both and such discrimination will provide information that is interpretable, and will account for the dynamic nature of AKI. […] During the last ten years new biomarkers have emerged for the diagnosis of AKI. […] A universal definition of AKI is important for its diagnosis and management. We need to find a way to incorporate in a definition of AKI, biomarkers that show direct injury together with biomarkers that currently are used for measurement of filtration function.

• #43 Acute Kidney Injury: Diagnostic Approaches and Controversies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5242479/

  The concept of AKI is based on rapid worsening of kidney function from baseline levels. […] However very often this is not available or unknown. Methods of looking back to obtain a baseline value for the initial detection of AKI have been studied and suggested by various organisations. […] UO is a rapid bedside test for kidney function. Reduced output is the oldest known biomarker for AKI. […] The accuracy and the usefulness of this criterion in clinical practice are not well verified. Very few studies have attempted to define an optimum UO and duration of urine collection for AKI diagnosis. […] In relation to AKI diagnosis, the UO criterion consistently classifies more patients as presenting with AKI than the sCr criteria. […] However the specificity of this criterion has not been defined yet. AKI patients are not stable patients and usually exhibit positive fluid balance, which alters the volume distribution (dilute) of sCr and results in overestimation of renal function and AKI diagnosis may be delayed by 48 to 72 h.

• #44 Acute Kidney Injury: Diagnostic Approaches and Controversies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5242479/

  The concept of AKI is based on rapid worsening of kidney function from baseline levels. […] However very often this is not available or unknown. Methods of looking back to obtain a baseline value for the initial detection of AKI have been studied and suggested by various organisations. […] UO is a rapid bedside test for kidney function. Reduced output is the oldest known biomarker for AKI. […] The accuracy and the usefulness of this criterion in clinical practice are not well verified. Very few studies have attempted to define an optimum UO and duration of urine collection for AKI diagnosis. […] In relation to AKI diagnosis, the UO criterion consistently classifies more patients as presenting with AKI than the sCr criteria. […] However the specificity of this criterion has not been defined yet. AKI patients are not stable patients and usually exhibit positive fluid balance, which alters the volume distribution (dilute) of sCr and results in overestimation of renal function and AKI diagnosis may be delayed by 48 to 72 h.

• #45 Acute Kidney Injury: Diagnostic Approaches and Controversies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5242479/

  Although a number of biomarkers of functional change and cellular damage are under evaluation for early diagnosis, risk assessment and prognosis of AKI, the current definitions in use (which are consensus definitions), include only the measurement of sCr and urinary output (UO) and they are far from being ideal. […] Moreover the lack of a true gold standard in the diagnosis of AKI means that we don’t have any data on the sensitivity and specificity of a creatinine based definition of AKI. […] These definitions may have helped clinicians to establish AKI diagnosis and staging, while urine examination can help in differential diagnosis. However after many years of clinical utilisation of these definitions, several limitations have been revealed. […] We also explore the current status of established and emerging biomarkers and how they can be used to further refine the definition of AKI.

• #46 Acute Kidney Injury | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17169

  Differential diagnoses to be considered in AKI include renal calculi, acute or chronic kidney disease, hypovolemia, gastrointestinal bleeding, decreased cardiac output, urinary tract infection, and urinary obstruction. […] Most prerenal AKI cases recover completely with correction of the underlying insult if treated early; however, the persistence of the underlying insult may lead to ATN, in which case the damage may not be completely reversible.

• #47 Acute Kidney Injury (AKI) – Nephrology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.14.1.

  Acute kidney injury (AKI) is a clinical syndrome arbitrarily defined by either an abrupt increase in serum creatinine concentration by 26.5 micromol/L (0.3 mg/dL) within 48 hours, a 1.5-fold increase in serum creatinine over the prior 7 days, or urine output 0.5 mL/kg/h for 6 hours. […] The diagnostic approach is broadly divided into 3 groups: prerenal, intrinsic (renal), and postrenal. […] The clinical presentation of AKI varies depending on the cause, severity, and associated diseases related to renal injury. Most patients with mild to moderate AKI are asymptomatic and identified by laboratory testing. […] Diagnostic Tests […] Blood laboratory tests: Serum creatinine and urea/blood urea nitrogen (BUN): Increased levels of serum creatinine and urea are important in assessing renal injury.

• #48 Differential Diagnosis of Acute Kidney Injury

  https://ddxof.com/acute-kidney-injury/

  Evaluation of AKI: 4 […] Condition Urinalysis Casts FeNa (%) […] Pre-renal Normal Hyaline 1 […] Intra-renal ATN Mild proteinuria Pigmented granular 1 […] AIN Mild proteinuria, Hb, WBC WBC casts, eosinophils 1 […] GN Moderate/severe proteinuria, Hb RBC casts 1 […] Post-renal Normal Crystals 1.

• #49 Acute Kidney Injury (AKI) – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

  Evaluation should determine the presence and type of AKI and seek a cause. Blood tests generally include complete blood count (CBC), BUN, creatinine, and electrolytes (including calcium and phosphate). Urine tests include sodium, urea, protein, and creatinine concentration; and microscopic analysis of sediment. Early detection and treatment increase the chances of reversing renal injury and, in some cases, preventing progression to the need for dialysis. […] A progressive daily rise in serum creatinine is diagnostic of AKI. […] Other laboratory findings are: Progressive acidosis, Hyperkalemia, Hyponatremia, Anemia. […] Prerenal causes are often apparent clinically. If so, correction of an underlying hemodynamic abnormality should be attempted. […] To further differentiate renal causes, antistreptolysin-O and complement titers, antinuclear antibodies, and antineutrophil cytoplasmic antibodies are determined. Renal biopsy may be done if the diagnosis remains elusive.

• #50 Evaluation of acute kidney injury among hospitalized adult patients – UpToDate

  https://www.uptodate.com/contents/evaluation-of-acute-kidney-injury-among-hospitalized-adult-patients

  It is important to quickly establish the cause of AKI. In many cases, AKI is reversible if the underlying cause is quickly identified and addressed. […] We take a systematic approach to the evaluation of patients with AKI. Even if the cause of AKI seems obvious, skipping steps in the diagnostic evaluation risks missing important causes of or contributors to AKI. […] A kidney biopsy is most commonly obtained when noninvasive evaluation has been unable to establish the correct diagnosis.

• #51 Acute kidney injury 2016: diagnosis and diagnostic workup | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1478-z

  Acute kidney injury (AKI) is common and is associated with serious short- and long-term complications. Early diagnosis and identification of the underlying aetiology are essential to guide management. […] Rapid diagnosis and appropriate diagnostic workup are essential to identify those types of AKI where specific therapies and interventions are available to reverse the injurious process within the kidneys. This review will summarise the key aspects of diagnosis and diagnostic work-up with particular focus on patients in the intensive care unit (ICU). […] The diagnosis of AKI is traditionally based on a rise in serum creatinine and/or fall in urine output. […] Accordingly, AKI is diagnosed if serum creatinine increases by 0.3 mg/dl (26.5 mol/l) or more in 48 h or rises to at least 1.5-fold from baseline within 7 days.

• #52 Acute kidney injury: diagnosis, staging and prevention – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/acute-kidney-injury-diagnosis-staging-and-prevention

  The diagnostic process starts with a detailed history, including a drug history. All patients with AKI should undergo urinalysis to differentiate between pre-renal AKI and the different forms of intrinsic AKI. […] Referral to a nephrologist should be considered for patients with stage 3 AKI, with indications for renal replacement therapy, in whom an intrinsic cause of AKI is suspected, or who are not improving despite actions to correct pre-renal causes of AKI. […] AKI is often avoidable. It is estimated that 20% of AKI that occurs after patients are admitted to hospital is predictable and avoidable. […] Mortality rates increase sharply as AKI worsens, and can be as high as 50% for patients with multi-organ failure.

• #53 Acute kidney injury: diagnosis, staging and prevention – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/acute-kidney-injury-diagnosis-staging-and-prevention

  The diagnostic process starts with a detailed history, including a drug history. All patients with AKI should undergo urinalysis to differentiate between pre-renal AKI and the different forms of intrinsic AKI. […] Referral to a nephrologist should be considered for patients with stage 3 AKI, with indications for renal replacement therapy, in whom an intrinsic cause of AKI is suspected, or who are not improving despite actions to correct pre-renal causes of AKI. […] AKI is often avoidable. It is estimated that 20% of AKI that occurs after patients are admitted to hospital is predictable and avoidable. […] Mortality rates increase sharply as AKI worsens, and can be as high as 50% for patients with multi-organ failure.

• #54 Acute Kidney Injury (AKI) | Doctor

  https://patient.info/doctor/acute-kidney-injury-pro

  Do not offer low-dose dopamine to treat acute kidney injury. […] AKI, if unrecognised and allowed to worsen, will result in progressive uraemia (toxic waste accumulation), metabolic acidosis, hyperkalaemia, spontaneous haemorrhage and pulmonary oedema if fluid balance is not carefully monitored. […] Any acute change in kidney function often indicates severe systemic derangement and predicts a poor prognosis. […] Early detection is likely to improve prognosis. Up to 30% of deaths from AKI are thought to be preventable by early recognition and management of patient risk factors. […] The best 'treatment’ of AKI is prevention. NICE guidance reflects this, with the emphasis being on identification of patients at risk. Close monitoring of urinary output and creatinine levels for these patients allows early detection. Avoidance of nephrotoxic drugs and iodinated contrast agents in these patients reduces the risk of them developing AKI.

• #55 Acute Kidney Injury – Kidney and Urinary Tract Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/kidney-and-urinary-tract-disorders/kidney-failure/acute-kidney-injury

  Acute kidney injury may be prolonged, necessitating removal of waste products and excess water. Waste removal can be done through dialysis, usually hemodialysis. If loss of kidney function is predicted to be prolonged or changes in diet and medication(s) are predicted to be ineffective, dialysis is started. […] Prognosis is worse for people in whom some other organs (such as the heart, lungs, or liver) are failing at the same time.

• #56 Acute Kidney Injury | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17169

  Differential diagnoses to be considered in AKI include renal calculi, acute or chronic kidney disease, hypovolemia, gastrointestinal bleeding, decreased cardiac output, urinary tract infection, and urinary obstruction. […] Most prerenal AKI cases recover completely with correction of the underlying insult if treated early; however, the persistence of the underlying insult may lead to ATN, in which case the damage may not be completely reversible.

• #57 Acute Kidney Injury: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1201/p687.html

  Acute kidney injury is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products. Acute kidney injury is associated with an increased risk of mortality, cardiovascular events, and progression to chronic kidney disease. Severity of acute kidney injury is classified according to urine output and elevations in creatinine level. Accurate diagnosis of the underlying cause is key to successful management and includes a focused history and physical examination, serum and urine electrolyte measurements, and renal ultrasonography when risk factors for a postrenal cause are present (e.g., older male with prostatic hypertrophy). […] The history and physical examination are important in determining the etiology of acute kidney injury. The history can identify nephrotoxic medications or a systemic illness contributing to impaired renal function. The physical examination should focus on evaluating intravascular volume status. Skin rashes may indicate an underlying condition (e.g., systemic lupus erythematosus, atheroembolism/vasculitis) or exposure (e.g., drug rash suggesting acute interstitial necrosis) leading to acute kidney injury.

• #58 Acute kidney injury 2016: diagnosis and diagnostic workup | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1478-z

  Future definitions are likely to incorporate novel functional and damage biomarkers to characterise AKI better. Early diagnosis and appropriate diagnostic work-up are essential to determine the underlying aetiology and to identify cases of AKI that require specific and timely therapeutic interventions.

• #59 Biomarkers in acute kidney injury | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01360-9

  Acute kidney injury (AKI) is a multifactorial syndrome with a high risk of short- and long-term complications as well as increased health care costs. The traditional biomarkers of AKI, serum creatinine and urine output, have important limitations. The discovery of new functional and damage/stress biomarkers has enabled a more precise delineation of the aetiology, pathophysiology, site, mechanisms, and severity of injury. This has allowed earlier diagnosis, better prognostication, and the identification of AKI sub-phenotypes. […] Despite its frequent occurrence, there are no specific therapies and only limited diagnostic tools used in routine clinical care. Traditionally, AKI is diagnosed by a rise in serum creatinine (sCr) and/or fall in urine output, independent of underlying aetiology, pathophysiology and anatomical site of injury.

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