Materiały źródłowe

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

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

  Treatment for acute kidney injury most often means a hospital stay. Most people with acute kidney injury are already in the hospital. How long you’ll stay in the hospital depends on the reason for your acute kidney injury and how quickly your kidneys recover. […] Treatment for acute kidney injury involves finding the illness or injury that damaged your kidneys. Your treatment depends on the cause. It might involve stopping a medicine that’s damaging your kidneys. […] Your healthcare team also works to prevent complications and give your kidneys time to heal. Treatments that help prevent complications include: […] If a lack of fluids in your blood is the cause of your acute kidney injury, you may need fluids through a vein, called intravenous (IV) fluids. […] If acute kidney injury causes you to have too much fluid, this may lead to swelling in your arms and legs. Then you may need medicines called diuretics, which cause your body to get rid of extra fluids.

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

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

  You might need medicines called potassium binders to keep potassium from building up. These include sodium zirconium cyclosilicate (Lokelma) or patiromer (Veltassa). […] If the levels of calcium in your blood drop too low, you might need to get calcium through a vein, called an infusion. […] If wastes build up in your blood, you may need hemodialysis for a time. Also called dialysis, it helps remove poisons and excess fluids from your body while your kidneys heal. […] Dialysis also may help remove excess potassium from your body. During dialysis, a machine pumps blood out of your body through an artificial kidney, called a dialyzer, that filters out waste. The blood is then returned to your body.

• #2 Acute Kidney Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441896/

  Acute kidney injury (AKI), previously known as acute renal failure, denotes a sudden and often reversible reduction in kidney function, as measured by increased creatinine or decreased urine volume. […] Distinguishing the causes of AKI is fundamental to effectively and efficiently treating AKI, which improves patient outcomes. […] Implement evidence-based guidelines for preventing and managing acute kidney injury, including optimizing fluid resuscitation, adjusting medications, and addressing underlying causes. […] The best way to determine if the AKI is prerenal or not is a fluid challenge. If there is no contraindication, all patients with acute renal dysfunction should receive a fluid challenge. […] If the renal function improves with fluid, this indicates prerenal AKI. […] Diuretics may be required during the oliguric phase of ATN if significant volume overload develops.

• #2 Acute Kidney Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441896/

  In some cases, short-term renal replacement therapy is needed for AKI until the kidney function recovers. […] Other treatments are directed at the etiology of the AKI. Examples include administering vasoactive medications and colloids for the treatment of hepatorenal syndrome, cautious diuresis in cardiorenal syndrome, immunosuppressive medication for various glomerulonephritides or vasculitides, or steroids for AIN. […] Postrenal obstruction may need to be relieved operatively in certain situations.

• #3 Acute kidney injury (AKI) | American Kidney Fund

  https://www.kidneyfund.org/all-about-kidneys/other-kidney-problems/acute-kidney-injury-aki

  AKI is very serious and needs to be treated right away to prevent lasting kidney damage. […] If AKI is treated early, most people will return to their previous kidney function. […] The treatment for AKI depends on the cause and severity. Some people need to be treated in a hospital and stay until their kidneys heal. Possible treatments include: […] Medicines to control your blood pressure and adjust the electrolytes in your blood […] Treatments to keep the right amount of fluid in your body (e.g. diuretics to make you pee out extra fluid) […] If the AKI is severe and your kidneys completely stop working, going on dialysis for a short period of time. Dialysis is a treatment that uses a machine to clean your blood. Dialysis will do the work that your kidneys should be doing until they can recover. […] When you return home, following a kidney-friendly eating plan to help your kidneys heal. Your doctor may refer you to a registered dietitian. […] You may have other treatments to optimize the healing of your kidneys.

• #4 Acute Kidney Injury (AKI) Treatment & Management: Approach Considerations, Vasodilators, Dietary Modification

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

  Measures to correct underlying causes of acute kidney injury (AKI) should begin at the earliest indication of kidney dysfunction. […] It cannot be overstated that the current treatment for AKI is mainly supportive in nature; no therapeutic modalities to date have shown efficacy in treating the condition. […] Maintenance of volume homeostasis and correction of biochemical abnormalities remain the primary goals of treatment and may include the following measures: Correction of fluid overload with furosemide, Correction of severe acidosis with bicarbonate administration, which can be important as a bridge to dialysis, Correction of hyperkalemia, Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with measures such as transfusions and administration of desmopressin or estrogens.

• #4 Acute Kidney Injury (AKI) Treatment & Management: Approach Considerations, Vasodilators, Dietary Modification

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

  Dietary changes are an important facet of AKI treatment. […] Indications for dialysis (ie, renal replacement therapy [RRT]) in patients with AKI are as follows: Volume expansion that cannot be managed with diuretics, Hyperkalemia refractory to medical therapy, Correction of severe acid-base disturbances that are refractory to medical therapy, Severe azotemia (BUN 80-100 mg/dL), Uremia. […] Great controversy exists regarding the timing of dialysis. […] The current recommendation by Kidney Disease: Improving Global Outcomes (KDIGO) in dialysis-dependent AKI patients is to deliver a urea clearance of 3.9 kt/v per week when using intermittent or extended RRT and an effluent volume of 20-25 mg/kg/hr when using continuous renal replacement therapy (CRRT). […] In patients undergoing imaging studies with contrast, prophylactic administration of IV fluid has been shown to decrease the incidence of contrast nephropathy.

• #4 Acute Kidney Injury (AKI) Treatment & Management: Approach Considerations, Vasodilators, Dietary Modification

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

  Furosemide can be used to correct volume overload when the kidneys are still responsive; this often requires high intravenous (IV) doses. […] Hyperkalemia in patients with AKI can be life-threatening. Approaches to lowering serum potassium include the following: Decreasing the intake of potassium in diet or tube feeds, Exchanging potassium across the gut lumen using potassium-binding resins, Promoting intracellular shifts in potassium with insulin, dextrose solutions, and beta agonists, Instituting dialysis. […] In AKI, the kidneys are especially vulnerable to the toxic effects of various chemicals. […] Nephrology consultation should be sought early in the course of AKI. A nephrologist can help to optimize management and avoid the preventable complications of AKI. […] The rationale for vasodilator therapy in AKI is that improved renal perfusion may reduce kidney damage.

• #4 Acute Kidney Injury (AKI) Treatment & Management: Approach Considerations, Vasodilators, Dietary Modification

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

  Renal recovery in most cases is not complete, with the kidneys remaining vulnerable to the nephrotoxic effects of all therapeutic agents. […] Remote ischemic preconditioning (RIPC) is a novel investigative method for preventing perioperative AKI. […] A review of randomized, controlled trials of pharmacologic measures used to protect kidney function perioperatively found no reliable evidence that any of the following interventions are effective: Dopamine and its analogues, Diuretics, Calcium channel blockers, Angiotensin-converting enzyme (ACE) inhibitors, N-acetylcysteine, Atrial natriuretic peptide (ANP), Sodium bicarbonate, Antioxidants, Erythropoietin (EPO), Specific hydration fluids.

• #5 Acute kidney injury

  https://www.nhs.uk/conditions/acute-kidney-injury/

  It’s essential that AKI is detected early and treated promptly. […] Treatment of AKI depends on what’s causing your illness and how severe it is. […] You may need to increase your intake of water and other fluids if you’re dehydrated. […] Antibiotics if you have an infection. […] To stop taking certain medicines (at least until the problem is sorted). […] A urinary catheter, a thin tube used to drain the bladder if there’s a blockage. […] You may need to go to hospital for some treatments. […] In severe cases, dialysis where a machine filters the blood to rid the body of harmful waste, extra salt and water may be needed.

• #6 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. […] General management principles for acute kidney injury include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function. […] Pharmacist-led quality-improvement programs reduce nephrotoxic exposures and rates of acute kidney injury in the hospital setting. […] Acute kidney injury care bundles are associated with improved in-hospital mortality rates and reduced risk of progression. […] Nephrology consultation should be considered when there is inadequate response to supportive treatment and for acute kidney injury without a clear cause, stage 3 or higher acute kidney injury, preexisting stage 4 or higher chronic kidney disease, renal replacement therapy, and other situations requiring subspecialist expertise.

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

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

  Management of acute kidney injury is primarily supportive, with the goals of preventing further damage and promoting recovery of renal function. […] If fluid resuscitation is indicated, isotonic crystalloids (e.g., 0.9% normal saline, lactated Ringer solution, Plasma-Lyte A) are recommended over colloids (e.g., albumin, dextran) as the initial therapy. […] A review of medications requiring discontinuation, dose adjustment, or monitoring is critical to the management of acute kidney injury. […] Because of a lack of benefit, diuretics are not recommended for the treatment or prevention of acute kidney injury, except to alleviate volume overload. […] If metabolic derangements from acute kidney injury do not respond to conservative treatment, renal replacement therapy, in consultation with a nephrologist, may be required.

• #7 Acute Kidney Injury – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

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

  Treatment involves correcting the cause of acute kidney injury and sometimes doing dialysis. […] Any treatable cause of acute kidney injury is treated as soon as possible. For example, if obstruction is the cause, a catheter (a tube placed into the bladder to remove urine), cystoscopy (procedure to look inside the bladder with a camera to eliminate the blockage), or surgery may be needed to relieve the obstruction. […] Often, the kidneys can heal themselves, especially if the kidney injury has existed for only a few days and there are no complicating problems such as infection. During this time, measures are taken to prevent the decreased kidney function from causing serious problems. Such measures may include the following: […] Starting dialysis. […] 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.

• #7 Acute Kidney Injury – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

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

  Dialysis helps control the complications of acute kidney injury. Dialysis may be needed only temporarily, until the kidneys recover their function, usually in several days to several weeks, sometimes after hospital discharge. If the kidneys do not recover, dialysis (hemodialysis or peritoneal dialysis) is continued indefinitely or kidney transplantation is pursued. […] Fluids are not restricted in people who are recovering from acute kidney injury caused by obstruction. During the recovery period, the kidneys are unable to reabsorb sodium and water normally, and a large amount of urine may be produced for a period of time after the obstruction is relieved. During recovery, people may need replacement of fluids and also electrolytes, such as sodium, potassium, and magnesium.

• #8 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084889/

  Acute kidney injury (AKI) is a complex and life-threatening condition with multifactorial etiologies, ranging from ischemic injury to nephrotoxic exposures. Management is founded on treating the underlying cause of AKI, but supportive care via fluid management, vasopressor therapy, kidney replacement therapy (KRT), and more is also crucial. […] There are no targeted pharmacotherapies for AKI itself, but some do exist for complications of AKI; additionally, medications become a key aspect of AKI management because changes in renal function and dialysis support can lead to issues with both toxicities and underdosing. […] Guidelines recommend prompt determination of the etiology of AKI to guide therapy, and this evaluation has become more robust with the use of newer tools like biomarkers that can supplement more traditional tools (history, volume assessment, response to diuretics, urinalysis, biopsy).

• #8 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084889/

  Pharmacologic advances have paved a way for targeted AKI therapy for certain etiologies, such as terlipressin in hepatorenal syndrome. […] Dialysis modalities have been updated and diversified, offering a range of options to address different patient needs when AKI progresses to the point of requiring kidney replacement therapy (KRT). […] This review highlights existing literature on AKI treatment. It focuses on blood pressure targets, fluid management, vasopressor therapy, indications for KRT, KRT timing, and important drug considerations in AKI. […] Blood pressure control is one of the most common medical problems in various healthcare settings. […] In hepatorenal syndrome (HRS), clinicians often aim for higher MAPs based on studies like CONFIRM (A Multi-Center, Randomized, Placebo Controlled, Double-Blind Study to Confirm Efficacy and Safety of Terlipressin in Subjects With Hepatorenal Syndrome Type 1), which showed benefit of terlipressin, a splanchnic and systemic vasoconstrictor, over placebo in improving kidney function.

• #8 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084889/

  Overall, the choice of vasopressor depends on clinical considerations, with vasopressin emerging as a potential renoprotective option. […] Blood pressure optimization, appropriate use of KRT, and medication management stand as key objectives in AKI management, though controversies persist. […] Most of these interventions are also debated. Some of the most controversial are diuretics and bicarbonate. […] In summary, MAP goals in AKI are often higher than normal, but specific targets should be individualized based on a patient’s baseline blood pressure and comorbidities as well as the etiology of AKI.

• #8 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084889/

  The most common indications for dialysis have become well known across specialties and levels of training, popularized by the mnemonic AEIOU—acidosis, electrolytes, ingestions, overload (of volume), and uremia. […] Ensuring kidney perfusion can help prevent and treat AKI, but inevitably some will require dialysis in the setting of AKI. […] Initiating dialysis is quite nuanced. […] An additional consideration in KRT initiation, particularly in the critically ill, is dialysis strategy—that is, continuous versus intermittent KRT. […] While continuous KRT (CKRT) has not shown any conclusive benefit in terms of survival and recovery of kidney function, it allows for slower solute and water removal and thereby is more hemodynamically tolerable, and is thus commonly used when patients in need of KRT are hemodynamically unstable.

• #9 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://www.mdpi.com/2077-0383/13/9/2455

  Understanding how to raise blood pressure and achieve MAP targets is crucial in AKI management. Mainly, we employ fluids and vasopressors. […] However, like with MAP targets, the process has nuances considering factors like the type and dosage of fluids and vasopressors, along with patient comorbidities. […] Causes of AKI are traditionally placed in three categories: prerenal, intrarenal, and postrenal. Prerenal etiologies, resulting from hypovolemia and kidney hypoperfusion, are often fluid-responsive. […] Yet, fluids may be detrimental in conditions like cardiogenic shock or obstructive AKI. […] The most common indications for dialysis have become well known across specialties and levels of training, popularized by the mnemonic AEIOU—acidosis, electrolytes, ingestions, overload (of volume), and uremia. […] For example, some providers will not initiate KRT for a certain blood urea nitrogen (BUN) threshold if there are no uremic complications.

• #9 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://www.mdpi.com/2077-0383/13/9/2455

  Guidelines recommend prompt determination of the etiology of AKI to guide therapy, and this evaluation has become more robust with the use of newer tools like biomarkers that can supplement more traditional tools (history, volume assessment, response to diuretics, urinalysis, biopsy). […] Pharmacologic advances have paved a way for targeted AKI therapy for certain etiologies, such as terlipressin in hepatorenal syndrome. Furthermore, recent research has provided new insights on factors that can be optimized in AKI, like blood pressure and volume status, and many have adopted a “goal-directed” approach to hemodynamic therapy, with additional studies underway. […] Blood pressure control is one of the most common medical problems in various healthcare settings. […] Most of the data on blood pressure targets in AKI come from studies on patients with sepsis, undergoing surgery, or post-cardiac arrest. These studies generally advocate for maintaining a higher mean arterial pressure (MAP) to ensure adequate kidney perfusion. Notably, guidelines such as those from the Surviving Sepsis Campaign recommend a target MAP of 65 mmHg in septic shock.

• #9 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://www.mdpi.com/2077-0383/13/9/2455

  Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations […] Acute kidney injury (AKI) is a complex and life-threatening condition with multifactorial etiologies, ranging from ischemic injury to nephrotoxic exposures. Management is founded on treating the underlying cause of AKI, but supportive care—via fluid management, vasopressor therapy, kidney replacement therapy (KRT), and more—is also crucial. […] Initiation of KRT is controversial, and studies have not consistently demonstrated any benefit to early start dialysis. There are no targeted pharmacotherapies for AKI itself, but some do exist for complications of AKI; additionally, medications become a key aspect of AKI management because changes in renal function and dialysis support can lead to issues with both toxicities and underdosing. This review will cover existing literature on these and other aspects of AKI treatment.

• #9 Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations

  https://www.mdpi.com/2077-0383/13/9/2455

  In addition to optimizing blood pressure and evaluating regularly for KRT indications, an important aspect of caring for patients with AKI is medication management. […] Drug dosing can be challenging in patients with evolving kidney function, but mistakes can lead to complications from underdosing to toxicity, and in some cases can even contribute to worsening AKI. […] Blood pressure optimization, appropriate use of KRT, and medication management stand as key objectives in AKI management, though controversies persist. […] Emerging options like alkaline phosphatase and L-Carnitine in sepsis-associated AKI, vitamin D in hospitalized AKI, and p53-targeted short interfering RNA in post-cardiac surgery AKI are under investigation, alongside non-pharmacologic interventions such as extracorporeal devices and remote ischemic preconditioning.

• #10 Acute Kidney Injury (AKI) Medication: Diuretics, Loop, Inotropic Agents, Vasodilators, Calcium Channel Blockers, Antidotes, Other

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

  Pharmacologic treatment of acute kidney injury (AKI) has been attempted on an empiric basis with varying success rates. Several promising experimental therapies in animal models are awaiting human trials. Experimental therapies include growth factors, vasoactive peptides, adhesion molecules, endothelin inhibitors, and bioartificial kidneys. Aminophylline has also been used experimentally for prophylaxis against kidney failure. […] There is no specific pharmacologic therapy proven to treat AKI secondary to hypoperfusion and/or sepsis. The only therapeutic or preventive intervention that has an established beneficial effect in the management of AKI is the intravenous (IV) administration of crystalloid solution. It should be given in quantities sufficient to keep the patient euvolemic or even hypervolemic.

• #10 Acute Kidney Injury (AKI) Medication: Diuretics, Loop, Inotropic Agents, Vasodilators, Calcium Channel Blockers, Antidotes, Other

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

  Although diuretics seem to have no effect on the outcome of established AKI, they appear to be useful in fluid homeostasis and are used extensively. They have also been used to reduce the requirement for renal replacement therapy. […] Furosemide increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the thick ascending loop of Henle and the distal renal tubule. It is a potent and rapid-acting agent with peak action at 60 minutes and a 6- to 8-hour duration of action. […] Dopamine stimulates adrenergic and dopaminergic receptors. Its hemodynamic effect is dose dependent. In small doses (eg, 0.5-3.0 mcg/kg/min), dopamine predominantly stimulates dopaminergic receptors, which, in turn produce vasodilation of the renal vasculature, enhancing renal perfusion.

• #11 Acute kidney injury – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-kidney-injury/

  Modalities include: […] Hemodialysis and/or hemofiltration (i.e., by CRRT or intermittent hemodialysis) […] The use of balanced IV fluid solutions has been associated with lower mortality and better renal outcomes compared with the use of normal saline in patients with AKI. […] Consider urgent renal replacement therapy for patients with refractory electrolyte or acid-base disturbances. […] Ensure adequate protein and calorie intake. […] Consider dietary potassium and/or phosphate restriction for patients with hyperkalemia and/or hyperphosphatemia. […] Monitor serum creatinine and urine output in at-risk neonates. […] Treat underlying causes. […] Avoid/adjust nephrotoxic medications. […] Provide supportive management (e.g., fluid, electrolyte, and nutritional). […] Consider renal replacement therapy.

• #11 Acute kidney injury – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-kidney-injury/

  Avoid coadministering RAAS inhibitors and NSAIDs in patients with reduced renal perfusion (e.g., in congestive heart failure, renal artery stenosis) because doing so can significantly decrease their GFR. […] Initiate treatment for the underlying cause of AKI based on the presumed mechanism. […] Provide supportive care to all patients. […] The goal of supportive care is to avoid further renal insult and potentially aggravating factors, support adequate kidney perfusion, and ensure early identification and treatment of complications. […] The longer the underlying cause has been present, the greater the chance that AKI will progress to renal failure and/or CKD. Treat potential causes of AKI early. […] Indications; consider urgently for: […] Complications refractory to medical management

• #11 Acute kidney injury – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-kidney-injury/

  Prerenal: volume repletion with IV crystalloids, hemodynamic support […] Postrenal: Relieve the obstruction; consult urology as needed. […] Intrinsic: Consider IV fluids. […] Identify and treat the underlying cause. […] Hold nephrotoxic substances and nonessential medications. […] Renally dose essential medications. […] Establish or maintain euvolemia. […] Blood pressure management […] Input/output monitoring […] Correct electrolyte disturbances. […] Manage acidosis. […] Nutritional support […] VTE prophylaxis […] Consult nephrology in patients with red flag features. […] Treatment is primarily supportive and aims to ensure adequate kidney perfusion and prevent complications and further kidney damage. […] AKI management is primarily supportive. Currently, there are no specific pharmacotherapies for AKI.

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

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

  Many cases overlap between prerenal and ATN types of AKI. The best way to determine if the AKI is prerenal or not is a fluid challenge. If there is no contraindication, all patients with acute renal dysfunction should receive a fluid challenge. This requires close monitoring of urine output and renal function. If the renal function improves with fluid, this indicates prerenal AKI. Acute tubular necrosis and other intrarenal causes are often slow to recover and can take weeks to months for complete recovery of renal function. Diuretics may be required during the oliguric phase of ATN if significant volume overload develops. It is also important to avoid further kidney insults, such as nephrotoxic drugs. In addition, many medications must be renally adjusted once a patient develops AKI. Dietary ingestion of potassium and phosphorus should also be monitored.

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

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

  Other treatments are directed at the etiology of the AKI. Examples include administering vasoactive medications and colloids for the treatment of hepatorenal syndrome, cautious diuresis in cardiorenal syndrome, immunosuppressive medication for various glomerulonephritides or vasculitides, or steroids for AIN. Postrenal obstruction may need to be relieved operatively in certain situations. For example, benign prostatic hypertrophy may require surgical intervention, and obstructive calculi may require stenting and lithotripsy.

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

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

  If hyperkalemia develops, it needs to be managed expeditiously. Approaches to lower potassium in the body include: […] Some AKI patients tend to develop volume overload, which should be corrected as early as possible to avoid pulmonary and cardiac complications. Euvolemic state can be achieved with the help of diuretics, which is a cornerstone in managing such patients. Usually, high doses of IV furosemide are needed to correct volume overload in AKI patients; however, it plays no role in converting oliguric AKI to non-oliguric AKI. […] In some cases, short-term renal replacement therapy is needed for AKI until the kidney function recovers. Some indications for RRT are severe and nonresponsive hyperkalemia, uremic pericarditis, and pulmonary edema. This is seen especially in the oliguric phase of acute tubular necrosis, where the patient is prone to develop multiple electrolyte and acid-base abnormalities as well as fluid overload. Dialysis in this setting is usually performed through a temporary venous catheter when required. Continuous renal replacement therapy can also be utilized in patients who cannot tolerate hemodialysis due to hypotension. It is a much slower, continuous type of dialysis. Correction of some of the metabolic abnormalities, along with dialysis, may be required. Metabolic acidosis is one such instance where systemic administration of citrate or bicarbonate is often required to maintain a suitable blood pH. The requirement for renal replacement therapy should be reevaluated daily. Renal replacement therapy is usually required for short periods, ranging from a few days to a few weeks; however, some cases can take months to recover and may require intermittent RRT support.

• #13 Acute kidney injury – Wikipedia

  https://en.wikipedia.org/wiki/Acute_kidney_injury

  The myriad causes of intrinsic AKI require specific therapies. For example, intrinsic AKI due to vasculitis or glomerulonephritis may respond to steroid medication, cyclophosphamide, and (in some cases) plasma exchange. Toxin-induced prerenal AKI often responds to discontinuation of the offending agent, such as ACE inhibitors, ARB antagonists, aminoglycosides, penicillins, NSAIDs, or paracetamol. […] If the cause is obstruction of the urinary tract, relief of the obstruction (with a nephrostomy or urinary catheter) may be necessary. […] Renal replacement therapy, such as with hemodialysis, may be instituted in some cases of AKI. Renal replacement therapy can be applied intermittently (IRRT) and continuously (CRRT). Study results regarding differences in outcomes between IRRT and CRRT are inconsistent. A systematic review of the literature in 2008 demonstrated no difference in outcomes between the use of intermittent hemodialysis and continuous venovenous hemofiltration (CVVH) (a type of continuous hemodialysis). Among critically ill patients, intensive renal replacement therapy with CVVH does not appear to improve outcomes compared to less intensive intermittent hemodialysis. However, other clinical and health economic studies demonstrated that, initiation of CRRT is associated with a lower likelihood of chronic dialysis and was cost-effective compared with IRRT in patients with acute kidney injury.

• #13 Acute kidney injury – Wikipedia

  https://en.wikipedia.org/wiki/Acute_kidney_injury

  The management of AKI hinges on identification and treatment of the underlying cause. The main objectives of initial management are to prevent cardiovascular collapse and death and to call for specialist advice from a nephrologist. In addition to treatment of the underlying disorder, management of AKI routinely includes the avoidance of substances that are toxic to the kidneys, called nephrotoxins. These include NSAIDs such as ibuprofen or naproxen, iodinated contrasts such as those used for CT scans, many antibiotics such as gentamicin, and a range of other substances. […] In prerenal AKI without fluid overload, administration of intravenous fluids is typically the first step to improving kidney function. Volume status may be monitored with the use of a central venous catheter to avoid over- or under-replacement of fluid.

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

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

  In patients with rapidly progressive glomerulonephritis, treatment with pulse steroids, cytotoxic therapy, or a combination may be considered, often after confirmation of the diagnosis by kidney biopsy. […] In some patients, the metabolic consequences of acute kidney injury cannot be adequately controlled with conservative management, and renal replacement therapy will be required. […] The indications for initiation of renal replacement therapy include refractory hyperkalemia, volume overload refractory to medical management, uremic pericarditis or pleuritis, uremic encephalopathy, intractable acidosis, and certain poisonings and intoxications (e.g., ethylene glycol, lithium).

• #14 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. […] Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances. […] Renal replacement therapy (dialysis) is indicated for refractory hyperkalemia; volume overload; intractable acidosis; uremic encephalopathy, pericarditis, or pleuritis; and removal of certain toxins. […] The main indication for use of diuretics is management of volume overload. […] However, it is important to note that diuretics do not improve morbidity, mortality, or renal outcomes, and should not be used to prevent or treat acute kidney injury in the absence of volume overload.

• #15 Acute Kidney Injury – Symptoms, causes, treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/acute-kidney-injury-aki

  Treatment for AKI depends on what caused it in the first place. This is why finding the cause is so important. Some most common approaches to treating AKI include: […] Stopping any medicines that may be causing or contributing to your AKI […] Giving you fluids (either by mouth or through your veins) […] Antibiotics (if AKI is caused by a bacterial infection) […] Placing a urine catheter (a thin tube used to drain your bladder, useful if AKI is caused by a blockage) […] Dialysis (depending on the severity of damage to your kidney and/or impact on your other organs) […] In most cases, dialysis treatments are only temporary until the kidneys can recover. […] Most people with AKI will need to spend some time in the hospital to be monitored while receiving treatment.

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

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

  Hemodialysis or hemofiltration is initiated when severe electrolyte abnormalities cannot otherwise be controlled (eg, potassium 6 mmol/L). […] Blood urea nitrogen (BUN) and creatinine levels are probably not the best guides for initiating dialysis in acute kidney injury (AKI). […] Nephrotoxic medications are stopped, and all medications excreted by the kidneys (eg, digoxin, some antibiotics) are adjusted; serum levels are useful. […] Sodium intake and potassium intake are minimized except in patients with prior deficiencies or gastrointestinal losses. […] An indwelling bladder catheter is rarely needed and should be used only when necessary because of an increased risk of urinary tract infection and urosepsis. […] In many patients, a brisk and even dramatic diuresis after relief of obstruction is a physiologic response to the expansion of extracellular fluid (ECF) during obstruction and does not compromise volume status.

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

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

  Treatment is directed at the cause but also includes fluid and electrolyte management and sometimes dialysis. […] Immediate treatment of pulmonary edema and hyperkalemia. […] Dialysis as needed to control hyperkalemia, pulmonary edema, metabolic acidosis, and uremic symptoms. […] Adjustment of medication regimen for degree of renal dysfunction. […] Usually restriction of water, sodium, phosphate, and potassium intake, but provision of adequate protein. […] Possibly phosphate binders (for hyperphosphatemia) and intestinal potassium binders (for hyperkalemia). […] Life-threatening complications are addressed, preferably in a critical care unit. […] Hyperkalemia is treated as needed with IV infusion of 10 mL of 10% calcium gluconate, 50 g of dextrose, and 5 to 10 units of insulin.

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

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

  Currently CRRT can be considered in patients with hemodynamic instability, acute brain injury, and increased intracranial pressure or generalized brain edema. […] Sodium bicarbonate (NaHCO3) is recommended in patients with severe acidosis to maintain a serum [HCO3] 8 mmol/L or arterial pH 7.2. […] Transfusion of packed red blood cells should be guided by the patients symptoms and clinical situation.

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

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

  1. All efforts should be made to eliminate the causes of AKI and to avoid factors that could worsen renal function, particularly nephrotoxic drugs. […] 2. Monitoring of fluid balance, including urine output, fluid intake, and daily body weight. […] 3. Frequent monitoring (at least daily) of serum creatinine, urea, potassium, sodium, and bicarbonate. […] 4. Adjust drug dosage to the severity of renal failure (note that GFR assessment in patients with AKI may not be reliable). […] 5. Provide appropriate nutrition: We recommend that protein intake should not be restricted to prevent or delay starting renal replacement therapy (RRT) in AKI as malnutrition has been associated with an increased likelihood of death, complications, and use of health-care resources. […] Treatment is aimed at addressing the underlying causes: shock and heart failure.

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

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

  Clinical indications: Volume overload (pulmonary edema) refractory to diuretic agents, uremic encephalopathy (altered mental status or seizures), pericarditis, uremic coagulopathy, overdosing certain drugs, and substance poisoning. […] Biochemical indications (approximations, ie, there is no decisive difference between a pH of 7.21 and 7.19): Refractory hyperkalemia (serum potassium 6.5 mmol/L), refractory metabolic acidosis (pH 7.2; bicarbonate level [HCO3] 8 mmol/L), refractory hypercalcemia (4.5 mmol/L), uremia 20 to 40 mmol/L (based on observational trials), refractory hypermagnesemia (3-5 mmol/L), severe dysnatremia (eg, 116 or 160 mmol/L; levels are reasonable examples only), or severe hyperuricemia in TLS. […] Numerous studies and meta-analyses failed to show benefits of CRRT as compared with standard intermittent RRT.

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

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

  In patients without hemorrhagic shock, volume restoration with crystalloids or albumin (rather than synthetic colloids) is recommended for initial management to restore effective circulatory volume. […] Treatment is aimed at addressing the underlying cause of kidney disease. Supportive care is necessary to eliminate any life-threatening complications, such as hypotension or severe metabolic complications. […] Treatment is aimed at rapid resolution of the urinary tract obstruction. […] The most commonly used types of RRT are intermittent or daily hemodialysis (HD), continuous renal replacement therapy (CRRT), sustained low-efficiency dialysis (SLED), and peritoneal dialysis (PD). […] The decision on when to start RRT should be based on clinical and biochemical features and involves individual clinical judgement.

• #18 Acute kidney injury: management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/acute-kidney-injury-management

  Post-renal AKI is diagnosed on ultrasound and patients suffering from the condition are often referred to a urologist for urgent treatment of urinary tract obstruction. […] The routine use of loop diuretics to drive urine output is not advocated and high-dose therapy is associated with an increased risk of ototoxicity. […] Administration of fluid also assists in the management of hypotension and should be used to increase systolic blood pressure to above 110mmHg. […] Some patients with AKI will present with fluid overload. […] To allow damaged kidneys to recover, all nephrotoxic medicines should be avoided if possible. […] Pharmacists should review the use of all medicines taken by a patient with AKI, particularly those that can exacerbate AKI symptoms. […] The toolkit recommends the following medicines should be stopped or avoided for patients with AKI: Angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers; Non-steroidal anti-inflammatory drugs; Cyclo-oxygenase-2 inhibitors; Metformin; Contrast media; Some analgesics (eg, renally cleared opioids); Disease-modifying antirheumatic drugs (eg, methotrexate).

• #19 Acute kidney injury – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000117

  Acute kidney injury (AKI) is commonly associated with sepsis, hypovolaemia, and/or hypotension (pre-kidney AKI and intrinsic AKI); nephrotoxins such as aminoglycoside antibiotics (e.g., gentamicin) and non-steroidal anti-inflammatory drugs (intrinsic AKI); or urinary outflow obstruction (post-kidney AKI). […] The mainstay of management is supportive care, with treatment of the underlying cause. Give particular attention to the prompt treatment of sepsis, optimisation of volume status, correction of acidaemia or electrolyte complications, avoidance of nephrotoxins, and relief of any obstruction. […] Renal replacement therapy may be needed for severe AKI with complications that do not respond to medical management. […] Prompt recognition and treatment is important; AKI occurs in 10% to 20% of emergency admissions and has an inpatient mortality 20% (35% for stage 3 AKI).

• #20 Acute Kidney Injury – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/perioperative/urinary/acute-kidney-injury/

  Medications can both affect and be affected by the kidneys, so its important that medications are reviewed in cases of AKI. […] Drugs to be potentially stopped: ACEi and ARBs, NSAIDs, Aminoglycoside antibiotics, Potassium-sparing diuretics (due to increased risk of hyperkalaemia). […] Drugs to be altered or reduced: Metformin (risk of lactic acidosis), Diuretics (in cases of intra-vascular fluid depletion), Low-molecular weight heparin. […] AKI is associated with worse patient outcomes and needs to be managed promptly. […] Ensure to treat the underlying condition and monitor regularly for response.

• #21 Acute kidney injury: A nursing challenge

  https://www.myamericannurse.com/acute-kidney-injury-challenge/

  To prevent AKI resulting from hypotension and shock, hemodynamic monitoring can include checking cardiac filling pressures. […] Nephrotoxic drugs play a role in 20% to 30% of AKI cases. […] Providers should avoid procedures that require iodinated radiocontrast in patients at risk for AKI. […] Acute or critical illness can cause stress hyperglycemia as a result of insulin resistance and anxiety response. […] If a patient with AKI becomes anuric and shows signs of a prolonged inability to clear electrolytes and waste, they meet the criteria for renal replacement therapy, which may include intermittent hemodialysis (IHD) and CRRT. […] CRRT for patients with severe AKI due to sepsis has the added benefit of removing endotoxins and cytokines, which have a direct correlation with mortality. […] For critically ill patients with AKI, nurses should conduct daily and periodic eGFR checks to monitor disease progression and treatment response.

• #21 Acute kidney injury: A nursing challenge

  https://www.myamericannurse.com/acute-kidney-injury-challenge/

  Acute kidney injury (AKI) is a common condition affecting hospitalized patients, particularly those who are critically ill. […] Monitoring serum creatinine, estimated glomerular filtration rate, and urine output is essential to AKI management. […] Prompt treatment of AKI aids in preventing life-threatening complications. […] AKI management requires interdisciplinary collaboration aimed at making renal dose adjustments, providing hemodynamic support, avoiding nephrotoxic medications, and preventing hyperglycemia. […] Nurses play a vital role in this care, as well as in managing continuous renal replacement therapy (CRRT). […] Based on the severity of kidney dysfunction, many renally cleared medications require serum-level checks, as well as dosage and frequency reviews and adjustments based on creatinine clearance or eGFR.

• #22 Acute Kidney (Renal) Failure: Symptoms, Causes, Treatment & Prevention

  https://www.webmd.com/a-to-z-guides/what-is-acute-kidney-failure

  Often, treatment for acute kidney failure, especially if severe, requires hospitalization. If there aren’t any other problems, the kidneys may heal themselves. […] In most other cases, acute kidney failure can be treated if it’s caught early. It may involve changes to your diet, the use of medications, IV fluids, relief of anything that’s blocking kidneys, or even dialysis. […] Your doctor will limit the amount of salt and potassium you get until your kidneys heal. That’s because both of these substances are removed from your body through your kidneys. […] Your doctor may prescribe medicines that regulate the amount of phosphorus and potassium in your blood. When your kidneys fail, they can’t remove these substances from your body. […] If your kidney damage is severe enough, you may require hemodialysis until your kidneys can heal. Dialysis does not help kidneys heal but takes over the work of kidneys until they do. If your kidneys don’t heal, dialysis could be long-term. […] It’s important to maintain a well-balanced diet that’s high in vitamins and nutrients and low in sodium. […] If treated soon enough, kidney damage from acute kidney failure can be reversed. Treatment includes finding out the cause and preventing complications while your kidneys heal.

• #23 Acute Kidney Injury Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/acute-kidney-injury/

  How is acute kidney injury treated? Your doctor or a kidney specialist (nephrologist) will try to treat the problem that is causing your kidney injury. Treatment can vary widely, depending on the cause. For example, your doctor may need to restore blood flow to the kidneys, stop any medicines that may be causing the problem, or remove or bypass a blockage in the urinary tract. […] At the same time, the doctor will try to: […] Stop wastes from building up in your body. You may have dialysis. This treatment does the work of your kidneys until they recover. It will help you feel better. […] Prevent other problems. You may take antibiotics to prevent or treat infections. You also may take other medicines to get rid of extra fluid and keep your body’s minerals in balance. […] You can help yourself heal by taking your medicines as your doctor tells you to. You also may need to follow a special diet to keep your kidneys from working too hard. You may need to limit sodium, potassium, and phosphorus. A dietitian can help you plan meals.

• #24 Kidney Failure: Stages, ESRD, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17689-kidney-failure

  Kidney failure treatment depends on the cause and severity of the condition. Healthcare providers cant cure kidney failure, and the disease is life-threatening. But treatment can help you live longer and manage any symptoms or complications. […] If youre in end-stage kidney failure, you need treatment to keep you alive. There are two main treatments for kidney failure: dialysis and a kidney transplant. […] Dialysis helps your body filter blood. You can think of it as giving your kidneys some relief, so they dont have to work as hard to do their job. There are two types of dialysis: Hemodialysis and Peritoneal dialysis. […] A surgeon places a healthy kidney in your body during a kidney transplant to take over for your damaged kidney. The healthy kidney (donor organ) may come from a deceased donor or a living donor. […] With proper treatment, you can continue to live a happy, fulfilling life. But, you can expect to need treatment for the rest of your life. Remember, you cant reverse kidney disease or kidney failure, you can only slow its progression.

• #25 Current therapeutic strategies for acute kidney injury | Renal Replacement Therapy | Full Text

  https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-023-00502-2

  Acute kidney injury (AKI) is an emerging public health problem worldwide and is associated with high morbidity and mortality. The high mortality rate can be attributed to the lack of pharmacological therapies to prevent and treat AKI. Renal replacement therapy (RRT) plays a pivotal role in the treatment of patients with severe AKI. However, the mortality rate of patients with AKI requiring RRT exceeds 50%. […] Recently, new therapeutic strategies for AKI have been developed. Angiotensin II and recombinant alkaline phosphatase treatment are expected to improve the clinical outcomes of patients with distributive and vasodilatory shock. Moreover, mitochondrial-targeted agents have been developed for the treatment of patients with AKI. […] The appropriate time to start RRT for AKI should be decided after consideration of individual clinical symptoms and disease conditions, as no optimal timing for RRT for patients with severe AKI has been established. There is insufficient evidence to recommend the early initiation of RRT. However, excessive delay of RRT initiation may lead to high mortality.

• #25 Current therapeutic strategies for acute kidney injury | Renal Replacement Therapy | Full Text

  https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-023-00502-2

  Two recent RCTs have shown a clinical benefit of angiotensin II in patients with vasodilatory shock. […] The two small RCTs that evaluated bovine intestinal AP treatment for patients with S-AKI demonstrated significantly improved kidney function. […] To date, there is insufficient evidence to recommend the use of AP in patients with S-AKI. Further well-designed, large RCTs are needed to confirm the utility of AP treatment for patients with S-AKI. […] New pharmacological interventions and therapies for AKI are expected to prevent its development and improve the clinical outcomes of patients with AKI.

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

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

  The timing to start RRT remains controversial. According to the KDIGO guidelines, RRT should be started when life-threatening changes in fluid, electrolyte, and acid-base balances exist, and it is recommended to consider the broader clinical context and trends of laboratory values when making the decision to start RRT.

• #27

  https://link.springer.com/article/10.1007/s00134-022-06859-y

  Acute kidney injury (AKI) is common in critically ill patients and is associated with serious short and long-term complications, including chronic dialysis dependence, and increased mortality. There is no approved pharmacological therapy to prevent, treat or enhance recovery from AKI. Current strategies focus predominantly on preventing further deterioration of renal function. […] Challenges in determining the exact timing, etiology, and phase of AKI may account for the limited progress in this field. […] Nevertheless, research addressing the pathophysiology of AKI has identified potential therapeutic targets, including pathways involved in hemodynamics and oxygen delivery, inflammation, cellular metabolism and oxidative stress, apoptosis, and cellular repair and fibrosis. […] Here, we describe selected compounds that impact known pathophysiological processes and have been studied in humans.

• #28

  https://newsroom.uw.edu/news-releases/study-homes-how-treat-acute-kidney-injury-patients

  By identifying meaningful AKI sub-phenotypes, the researchers think they have taken a significant step to help physicians predict which critically ill patients will respond better to vasopressin therapy. […] We commonly use vasopressin, and its already approved by the FDA, so that is probably the best drug to study further, he said. The other option would be to try to develop new therapeutics that target these specific patient clusters. […] Rapid, bedside assays would need to be developed to identify patients for these AKI clusters. […] Precision medicine has mostly focused on improving cancer care. This is one of the few circumstances in which we can treat critically ill patients differently based on their physiologic response with kidney injury.

• #28

  https://newsroom.uw.edu/news-releases/study-homes-how-treat-acute-kidney-injury-patients

  By clustering patients based on blood levels of select biomarkers, researchers learned who is likelier to benefit from a specific therapy. […] Despite therapeutic interventions, some cases of acute kidney injury deteriorate, requiring dialysis. […] Doctors in intensive care units, where most of these patients are treated, employ a standard treatment, but the wide array of contributing factors make it unclear how any individual patient will respond. […] New study findings, however, shed light on which patients are likelier to benefit from a specific therapy. […] The researchers then applied their two-cluster model to findings from a 2008 study that tested two therapies for septic shock, a condition frequently involved in AKI. […] We grouped the study subjects into our two clusters, Bhatraju said. Cluster 1 had a significant improvement in mortality at 28 days and 90 days with vasopressin therapy. Cluster 2 had no treatment benefit between vasopressin versus standard of care.

• #29 Advancing understanding and treatment of acute kidney injury

  https://medicalxpress.com/news/2025-04-advancing-treatment-acute-kidney-injury.html

  „By categorizing the injury into these four buckets, we are thinking about how the immune system affects both unique and shared pathways–and hope to identify targets for much more effective therapies in all types of AKI.” […] Prioritizing the types of therapy or the immune system’s ability to repair the kidney could lead to new insights into improving the outcome of AKI, the researchers said.

• #30 New Discoveries in Treatment and Recovery from Acute Kidney Injury: A Q&A with Dr. Frank Maddux

  https://freseniusmedicalcare.com/en-us/insights/articles/acute-kidney-injury-treatment-and-recovery-dr-frank-maddux/

  Its very exciting because weve never been able to look at this on a population basis with a large national sample of patients with AKI. […] Our data highlights the potential for renal recovery after 90 days. Its important to not give up on peoples possibility of recovering at a late stage. […] Knowing more about the causes of AKI and the natural history of recovery will help to personalize an approach for those suffering from such a severe systemic disorder.

• #30 New Discoveries in Treatment and Recovery from Acute Kidney Injury: A Q&A with Dr. Frank Maddux

  https://freseniusmedicalcare.com/en-us/insights/articles/acute-kidney-injury-treatment-and-recovery-dr-frank-maddux/

  A preliminary analysis of new data from more than 9,000 patients with acute kidney injury receiving outpatient dialysis provides important insights, including that a significant number have long term recovery of kidney function. […] I believe this data holds enormous promise for developing important insights into the treatment and recovery of acute kidney injury. We hope to use these insights to improve the treatment of people with AKI and create more personalized care that enhances the likelihood of recovery of kidney function. […] Our analysis showed that about one-third of AKI patients who begin outpatient dialysis will recover kidney function in the first 90 days of starting their outpatient treatment. About 1 in 6 patients with persistent acute kidney injury after 90 days will actually regain kidney function by day 150.

• #31 Acute Kidney Injury: Symptoms and Treatment

  https://patient.info/kidney-urinary-tract/acute-kidney-injury-leaflet

  There isn’t a specific medicine to treat AKI. The treatment will depend on the cause of AKI and the severity of the AKI. […] The treatment is to carefully look after all the things the kidneys usually do. You will normally be in hospital and have blood and urine tests regularly. You are likely to need extra fluid or a particular type of fluid through a drip. […] You may be on a restricted diet to help get the balance of proteins and salts right. Any medicines which might be harming your kidneys would be stopped. […] The cause of the problem would be treated if this is possible. (For example, you might need antibiotics for an infection or surgery for any blockage if these were the cause.) […] Your doctor will keep a close eye on the balance of minerals and salts in your body. You will have regular tests for potassium, sodium, calcium, sugar (glucose), phosphate and creatinine. You may need treatment with medicines or through a drip if the levels are not right.

• #32 Acute Kidney Injury | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117660/all/Acute_Kidney_Injury

  Fluid resuscitation is the mainstay of treatment of AKI, both in prerenal and in some forms of intrinsic kidney injury. In severe cases of kidney injury, renal replacement therapy (RRT) may be required. The most important aspect of treating AKI is determining the underlying cause. […] Identify and correct prerenal and postrenal causes; stop nephrotoxic drugs and renally dose others. Strictly monitor intake/output and daily weight; optimize cardiac output to maintain renal perfusion. Optimize nutrition and treat any infections. Remove obstruction by placing a Foley catheter, suprapubic catheter, or nephrostomy tube as clinically indicated. […] Indications for RRT: volume overload, severe hyperkalemia, or metabolic acidosis refractory to medical management; advanced uremic complications (pericarditis, encephalopathy, bleeding diathesis); pulmonary edema.

• #33 Acute Kidney Injury Treatment

  https://www.freseniuskidneycare.com/kidney-disease/acute-kidney-injury/treatment

  During your dialysis treatment your care team will be monitoring you closely. Weekly laboratory tests may be used to check your kidney function. These tests will help your doctor and care team adjust your treatment and monitor the progress of your recovery. […] If you have AKI or AKF, there are certain medications that should be avoided while your kidneys are recovering. Common medications with possible risks for people with AKI include NSAIDs, ACE inhibitors, ARBs, certain antibiotics, and diabetes medications. […] When your kidneys are injured, many medications require close adjustment because they’re cleared through your kidneys and could cause additional harm. […] With AKI, kidney function may be regained if proper AKI treatment is received quickly. […] If AKI is not reversed, it may lead to permanent kidney failure and require further treatment, including ongoing dialysis or a transplant. Your care team will help you manage your treatment plan for kidney failure.

• #34 Acute Kidney Injury (AKI) TOOLKIT​ – International Society of Nephrology

  https://www.theisn.org/initiatives/toolkits/acute-kidney-injury-aki-toolkit/

  Early referral for those patients who do not respond favourably to initial interventions. […] Please consider referring a patient to a specialist if severe AKI is present (AKI stage 3) or acute-on-chronic kidney injury, if the underlying cause is not readily apparent or if there’s suspicion of an intrinsic renal disease. […] Patients with AKI should be followed up within 3 months after discharge. […] Follow-up visit should include check on kidney function or damage. […] Certain categories of patient with AKI may need earlier follow-up (within 2 to 4 weeks). […] Atypical clinical course or failure to recover during follow-up: Necessitate specialist referral to ascertain the cause.

• #35 Kidney – acute kidney injury | Healthify

  https://healthify.nz/health-a-z/k/kidney-acute-kidney-injury

  Acute kidney injury (AKI) means that your kidneys have suddenly stopped working as well as they used to. […] It’s essential that AKI is detected early to increase the chances that treatment can help your kidneys fully recover. […] If it’s not picked up in time, your kidneys can deteriorate quite quickly and shut down. This can lead to permanent damage and can be life threatening if not detected within hours and treated quickly. […] Taking some medicines increases your risk of getting AKI, especially if you take these medicines while you are dehydrated, or you take a combination of these medicines. […] After AKI you can make a full recovery and have normal kidney function or you can make a partial recovery with lower levels of kidney function. Some people may have permanent kidney damage that requires dialysis. […] It’s recommended that you get your kidney function checked out by your healthcare provider every year for the first 3 years following an AKI.

• #36 What Is Rehabilitation Therapy of Acute Kidney Damage?

  https://www.icliniq.com/articles/kidney-and-urologic-diseases/rehabilitation-therapy-for-acute-kidney-damage

  Acute kidney damage causes a sudden decline in kidney functioning, requiring rehabilitation therapy to prevent its progression to chronic kidney disease. […] It is important to provide rehabilitation therapy, lifestyle changes, medicines, control of blood pressure, and education for the patients after episodes of acute kidney injury as they belong to high-risk groups. If left untreated, this disease could lead to complications and death. […] Treatment of acute kidney damage should be facilitated in the hospital. The interventions the patient receives in the hospital are listed below. […] Research suggests including management strategies and post-follow-up care to enhance recovery after acute kidney damage. […] The rehabilitation program should include strategies and therapies to prevent complications and promote faster renal recovery.

• #36 What Is Rehabilitation Therapy of Acute Kidney Damage?

  https://www.icliniq.com/articles/kidney-and-urologic-diseases/rehabilitation-therapy-for-acute-kidney-damage

  Renal rehabilitation enhances the patient’s functional level in the social, psychological, and physiological dimensions, reducing mortality and morbidity. […] The patient must be treated for his underlying disease to promote renal repair. Immunosuppressives, cytotoxic drugs, and steroids are used in renal rehabilitation. […] After acute kidney damage, simple dietary and life advice is given to promote renal and cardiovascular health. […] The physiotherapist’s contribution to renal rehabilitation is to create a well-thought-out, extensive exercise regimen. […] Managing patients with acute kidney injury involves exercise and physiotherapy for renal rehabilitation. […] An exercise rehabilitation program improves renal recovery after acute renal damage and reduces the risk of progression to chronic kidney disease.

• #37

  https://www.kidney.org.uk/acute-kidney-injury

  If illness causing AKI affects other parts of the body so that the blood pressure is very low or the breathing is badly affected, it may be necessary to go to the Critical Care Unit (or Intensive Care Unit). […] In some cases, AKI may resolve in a couple of days with fluid and antibiotics. […] The kidneys may go completely back to normal. But if the kidneys were not normal to start off with, they may not make a complete recovery. […] If you recover from AKI, you should check with the doctors to see what warning signs you should look out for in the future that might help prevent further AKI.

• #38 Acute Kidney Failure Treatment, Recovery Time, Defintion

  https://www.emedicinehealth.com/acute_kidney_failure/article_em.htm

  Most people with acute kidney failure improve when the cause of the kidney failure is removed or treated and don’t require dialysis. Normal kidney function is usually restored, though in some cases, residual damage only allows partial restoration of the kidney function. Such patients may not require dialysis but may need medicines to supplement lost kidney function. […] The patient may be given medicines to treat the cause of the acute renal failure or to prevent complications. Antibiotics: To prevent or treat infections; Diuretics (water pills): Quickly increase urine output; Other medications: To get rid of extra fluid and prevent electrolyte imbalances. […] The doctor will arrange follow-up visits as needed for the underlying cause of the kidney failure and the severity of the disease. Underlying condition(s) will be monitored and appropriate lab tests will be performed to be sure that the kidney failure has resolved. Preventive measures may be needed in some situations to prevent the problem from occurring again.

• #39 Acute kidney injury – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048

  Acute kidney injury happens when the kidneys suddenly can’t filter waste products from the blood. […] Acute kidney injury ranges from mild to severe. If severe, ongoing and not treated, it can be fatal. But it also can be reversed. People in otherwise good health may get back typical or nearly typical use of their kidneys. […] See your healthcare professional right away or seek emergency care if you have symptoms of acute kidney injury. […] You might cut your risk of acute kidney injury by taking care of your kidneys. Try to: Work with your healthcare team to manage kidney and other ongoing conditions. Kidney disease, diabetes or high blood pressure increases your risk of acute kidney injury. If you have one of these, do what your healthcare team tells you to manage your condition. […] Sometimes, acute kidney injury causes no symptoms. Then it may be found through lab tests done for something else.

• #40 Acute Kidney Injury Causes, Symptoms, and Treatments

  https://www.upmc.com/services/kidney-disease/conditions/acute-kidney-injury

  To reduce stress on your kidneys during and after your AKI treatment, you may need to work with a registered dietitian and follow a special eating plan. […] In some cases, AKI can be cured by treating the cause of kidney injury. However, AKI can sometimes cause permanent kidney damage. […] AKI may be reversible if the cause of the injury is treatable and there is no permanent kidney damage. […] The effectiveness of AKI treatment depends on the cause of your condition and whether it has resulted in permanent kidney damage. Your kidneys may heal fully over time, or permanent damage may require ongoing treatment. […] Mild cases of AKI may get better in a few days with observation or minimal treatment. Severe cases of AKI may get better in weeks or months or may cause permanent kidney damage that requires ongoing treatment. Your doctor will monitor your condition and discuss your expected recovery time.

Zobacz więcej