Acute kidney injury: Difference between revisions
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==Classification== | ==Classification== | ||
===Prerenal=== | ===Prerenal=== | ||
This is characterized by fractional excretion of sodium in the urine of < 1%.<ref name="pmid666184">{{cite journal |author=Miller TR, Anderson RJ, Linas SL, ''et al'' |title=Urinary diagnostic indices in acute renal failure: a prospective study |journal=Ann. Intern. Med. |volume=89 |issue=1 |pages=47–50 |year=1978 |pmid=666184 |doi=}}</ref> | This is characterized by [[fractional excretion of sodium]] in the urine of < 1%.<ref name="pmid666184">{{cite journal |author=Miller TR, Anderson RJ, Linas SL, ''et al'' |title=Urinary diagnostic indices in acute renal failure: a prospective study |journal=Ann. Intern. Med. |volume=89 |issue=1 |pages=47–50 |year=1978 |pmid=666184 |doi=}}</ref> | ||
Causes include: | Causes include: | ||
* Hypovolemia | * Hypovolemia | ||
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===Intrarenal=== | ===Intrarenal=== | ||
Also simply called 'renal', this is characterized by fractional excretion of sodium in the urine of > 1%.<ref name="pmid666184"/> | Also simply called 'renal', this is characterized by [[fractional excretion of sodium]] in the urine of > 1%.<ref name="pmid666184"/> | ||
Causes include: | Causes include: | ||
* Glomerulonephritis (GN). This is characterized by significant proteinuria, red cells in the urine (possibly dysmorphic in appearance), and red-cell casts.<ref name="pmid17928602">{{cite journal |author=Rabb H, Colvin RB |title=Case records of the Massachusetts General Hospital. Case 31-2007. A 41-year-old man with abdominal pain and elevated serum creatinine |journal=N. Engl. J. Med. |volume=357 |issue=15 |pages=1531–41 |year=2007 |pmid=17928602 |doi=10.1056/NEJMcpc079024}}</ref> GN may be caused by [[vasculitis]]. | * Glomerulonephritis (GN). This is characterized by significant proteinuria, red cells in the urine (possibly dysmorphic in appearance), and red-cell casts.<ref name="pmid17928602">{{cite journal |author=Rabb H, Colvin RB |title=Case records of the Massachusetts General Hospital. Case 31-2007. A 41-year-old man with abdominal pain and elevated serum creatinine |journal=N. Engl. J. Med. |volume=357 |issue=15 |pages=1531–41 |year=2007 |pmid=17928602 |doi=10.1056/NEJMcpc079024}}</ref> GN may be caused by [[vasculitis]]. | ||
Revision as of 10:56, 4 January 2008
Acute kidney injury, previously called acute renal failure, is defined as as "An abrupt (within 48 hours) reduction in kidney function currently defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl (≥ 26.4 μmol/l), a percentage increase in serum creatinine of more than or equal to 50% (1.5-fold from baseline), or a reduction in urine output (documented oliguria of less than 0.5 ml/kg per hour for more than six hours)."[1]
Classification
Prerenal
This is characterized by fractional excretion of sodium in the urine of < 1%.[2] Causes include:
- Hypovolemia
- Hepatorenal syndrome
- Vascular disease
Intrarenal
Also simply called 'renal', this is characterized by fractional excretion of sodium in the urine of > 1%.[2] Causes include:
- Glomerulonephritis (GN). This is characterized by significant proteinuria, red cells in the urine (possibly dysmorphic in appearance), and red-cell casts.[3] GN may be caused by vasculitis.
- Acute tubular necrosis (ATN). ATN is characterized by pigmented granular casts in the urine sediment.[3] Causes of ATN include radiocontrast media and non-steroidal anti-inflammatory agents.
- Interstitial nephritis.
Post-renal
This is characterized by symptoms of obstruction and sometimes by anuria.
Treatment
The underlying cause of the kidney injury should be treated. Diuresis has been investigated as a nonspecific treatment, but no benefit was found.[4]
If fluid resuscitation is used, the type of fluid probably does not matter according to a [meta-analysis]] of randomized controlled trials by the Cochrane Collaboration.[5]
References
- ↑ Mehta RL, Kellum JA, Shah SV, et al (2007). "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury" 11 (2): R31. DOI:10.1186/cc5713. PMID 17331245. Research Blogging.
- ↑ 2.0 2.1 Miller TR, Anderson RJ, Linas SL, et al (1978). "Urinary diagnostic indices in acute renal failure: a prospective study". Ann. Intern. Med. 89 (1): 47–50. PMID 666184. [e]
- ↑ 3.0 3.1 Rabb H, Colvin RB (2007). "Case records of the Massachusetts General Hospital. Case 31-2007. A 41-year-old man with abdominal pain and elevated serum creatinine". N. Engl. J. Med. 357 (15): 1531–41. DOI:10.1056/NEJMcpc079024. PMID 17928602. Research Blogging.
- ↑ Ho KM, Sheridan DJ (2006). "Meta-analysis of frusemide to prevent or treat acute renal failure". BMJ 333 (7565): 420. DOI:10.1136/bmj.38902.605347.7C. PMID 16861256. Research Blogging.
- ↑ Perel P, Roberts I (2007). "Colloids versus crystalloids for fluid resuscitation in critically ill patients". Cochrane Database Syst Rev (4): CD000567. DOI:10.1002/14651858.CD000567.pub3. PMID 17943746. Research Blogging.