Acute Kidney Injury (AKI) Treatment

What is Acute Kidney Injury (AKI)?

Acute kidney injury (AKI) is a sudden loss of kidney function, occurring over hours to days, which results in the kidneys being unable to filter waste products, balance fluids, or regulate electrolytes effectively. It can be caused by factors such as reduced blood flow to the kidneys (sepsis, heart failure, dehydration), direct kidney damage (medications, toxic exposures, autoimmune diseases), or urinary blockage (kidney stones, inability to empty bladder). AKI is a serious condition that requires prompt medical attention, as it can lead to complications or progress to chronic kidney disease, and potentially death, if not managed appropriately.

Our Comprehensive Approach to AKI Treatment

At Advanced Kidney Care PLLC, we understand the critical nature of AKI and provide immediate, evidence-based interventions to treat this serious condition. Our approach focuses on identifying and treating the root causes of AKI to achieve optimal patient treatment plans and outcomes.

Below is some information the more common causes of AKI and initial remedies to help prevent worsening disease. Please note, this is for education only and we always recommend seeking the advice of your medical provider for any underlying medical illnesses/conditions. Advanced Kidney Care, PLLC, will not be held liable for any of the information found on this page.

Hypovolemia

Hypovolemia, a condition characterized by decreased blood volume, can lead to acute kidney injury (AKI) due to inadequate blood flow (perfusion) to the kidneys, causing ischemic injury to kidney tissues. This reduced perfusion compromises the kidneys’ ability to filter blood, resulting in the buildup of waste products and electrolyte imbalances. Common causes of hypovolemia include reduced liquid intake, nausea/vomiting, diarrhea, excessive sweating). Signs and symptoms of hypovolemia include low blood pressure, increased heart rate, dry mucous membranes, decreased urine output, and cool, clammy skin. Treatment typically involves avoiding certain medications (NSAIDs, blood pressure medications, diuretics) and addressing the underlying cause.

Initial Management*

Stop taking NSAIDs, diuretics, blood pressure medications
Increase fluid and salt intake.
If unable to keep fluids down, having persistently low blood pressure or progressively worsening, call your medical provider for further guidance.

Acute Tubular Necrosis (ATN)

cute tubular necrosis (ATN), AKA "Shock Kidney," is a common cause of acute kidney injury (AKI) characterized by damage to the kidney's tubular cells, often resulting from ischemia (reduced blood flow) or exposure to nephrotoxic substances. This damage impairs the kidney’s ability to filter and reabsorb fluids and electrolytes, leading to waste accumulation in the blood. Risk factors for ATN include prolonged hypotension, sepsis, major surgery, use of nephrotoxic drugs (e.g., aminoglycosides, contrast dyes), severe dehydration, and conditions like rhabdomyolysis or hemolysis. Signs and symptoms of kidney failure associated with ATN include decreased urine output, swelling, fatigue, confusion, nausea, and elevated blood levels of creatinine and urea.

Initial Management*

Stop offending agent/cause
Seek immediate medical attention

Congestive Heart Failure (CHF)

Congestive heart failure (CHF) can lead to acute kidney injury (AKI) due to reduced cardiac output, which decreases blood flow (perfusion) to the kidneys, causing ischemic damage. This impaired perfusion activates the renin-angiotensin-aldosterone system (RAAS), leading to fluid retention and further strain on both the heart and kidneys, exacerbating kidney injury. Risk factors for developing AKI due to CHF include advanced age, pre-existing kidney disease, hypertension, diabetes, and volume overload. Signs and symptoms of heart failure include shortness of breath, fatigue, swelling in the legs or abdomen, weight gain, reduced exercise tolerance, and jugular vein distention.

Initial Management*

Restrict sodium intake < 2 grams per day
Restrict fluid intake to 48 ounces per day (yes....all fluids such as coffee, tea, water, pop, juices, beer, etc.)
Remain compliant with diuretic therapy
If developing leg swelling with worsening shortness of breath, especially while laying flat, contact your medical provider immediately for further direction

Analgesic Nephropathy (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause acute kidney injury (AKI) by impairing the kidneys’ ability to regulate blood flow. NSAIDs inhibit cyclooxygenase enzymes (COX-1 and COX-2), reducing the production of prostaglandins, which are crucial for maintaining adequate blood flow to the kidneys, especially during stress or dehydration. This can lead to decreased perfusion, ischemia, and kidney damage. Risk factors for NSAID-induced AKI include dehydration, pre-existing kidney disease, heart failure, advanced age, and concurrent use of other nephrotoxic drugs like ACE inhibitors or diuretics. Signs and symptoms of renal failure may include reduced urine output, swelling in the legs or face, nausea, confusion, fatigue.

Initial Management*

Stop taking NSAIDs (ibuprofen, Motrin, Advil, naproxen, Aleve, meloxicam (Mobic)
Okay to use topical diclofenac gel (Voltaren® gel) on sites of pain in place of oral NSAIDs
Address contributing factors (concurrent nausea/vomiting/diarrhea, different pain medication regimen, etc.)

Kidney Stones

Kidney stones can lead to acute kidney injury (AKI) by causing obstruction in the urinary tract, blocking the flow of urine and increasing pressure in the kidney. This obstruction can impair kidney function, reduce blood flow, and lead to tissue damage or infection (pyelonephritis), worsening the injury. Risk factors for kidney stones include dehydration, high dietary intake of salt, oxalates, or animal proteins, genetic predisposition, obesity, certain medications, and medical conditions such as hyperparathyroidism or gout. Signs and symptoms of kidney stones include severe flank or abdominal pain, hematuria (blood in urine), nausea, vomiting, difficulty urinating, and fever or chills if an infection is present.

Initial Management*

Stay hydrated
Seek immediate medical attention

Rhabdomyolysis

Rhabdomyolysis causes acute kidney injury (AKI) due to the release of large amounts of myoglobin from damaged muscle tissue into the bloodstream. Myoglobin can accumulate in the kidneys, causing tubular obstruction, oxidative stress, and direct toxicity to kidney cells, especially in the presence of dehydration or acidosis. Risk factors for AKI due to rhabdomyolysis include severe muscle trauma, prolonged immobility, excessive exercise, drug or alcohol abuse, certain medications (e.g., statins), and conditions like seizures or heatstroke. Signs and symptoms of rhabdomyolysis include muscle pain or weakness, dark or tea-colored urine (from myoglobinuria), fatigue, nausea, and swelling of affected muscles.

Initial Management*

Stop all cholesterol medications
Increase fluid intake
Avoid strenuous activity
Contact your medical provider immediately

Glomerulonephritis

Glomerulonephritis is an inflammation of the glomeruli, the tiny filtering units in the kidneys responsible for removing waste and excess fluids from the blood. This inflammation can impair the filtration process, leading to a buildup of waste products and fluids, ultimately causing acute kidney injury (AKI) if severe. Causes of glomerulonephritis include autoimmune diseases (e.g., lupus, IgA nephropathy), infections (e.g., post-streptococcal glomerulonephritis), vasculitis, or diseases such as Goodpasture syndrome. Signs and symptoms of glomerulonephritis may include hematuria (blood in urine), proteinuria (excess protein in urine), swelling (edema) in the face, hands, or legs, high blood pressure, and reduced urine output.

Initial Management*

Seek immediate medical attention