Acute Kidney Injury Treatment in India

Overview

What is acute kidney injury?

Acute kidney injury (AKI) occurs when the kidneys suddenly lose their ability to effectively filter waste products from the blood. As a result, harmful waste substances may accumulate in the body, and the chemical balance of the blood may become disturbed.

Previously referred to as acute kidney failure, acute kidney injury is most commonly seen in hospitalised individuals, particularly those requiring intensive care.

The severity of acute kidney injury can range from mild to severe. If severe, persistent, and left untreated, it may become life-threatening. However, the condition can often be reversible, and individuals who are otherwise healthy may recover normal or near-normal kidney function.

Symptoms

Symptoms of AKI may include:

Reduced urine output
Fluid retention leading to shortness of breath and swelling of the legs, ankles, or feet
Fatigue or low energy levels
Confusion or difficulty thinking clearly
Nausea
Pain in the abdomen or along the side below the ribs
Weakness
Irregular heartbeat
Itching
Loss of appetite
Chest pain or a feeling of pressure in the chest
Seizures or coma in severe cases

Diagnosis

If AKI is suspected, a healthcare professional may perform a physical examination, review medical history and recent medication use, ask about recent symptoms and relevant experiences, and recommend blood and urine tests to identify the possible cause.

Tests

Common tests used to diagnose or evaluate AKI include:

Serum creatinine test - a blood test used to assess how effectively the kidneys are filtering creatinine, a waste product, from the blood
Estimated glomerular filtration rate (eGFR) - calculated using serum creatinine level, age, and sex to estimate kidney function
Blood urea nitrogen (BUN) test - measures another waste product in the blood to evaluate kidney filtration function
Additional blood tests - including sodium, potassium, and bicarbonate levels to identify any chemical imbalances
Urine output monitoring - measurement of the amount of urine passed daily, especially in hospitalized patients with AKI
Urinalysis - a urine test that may provide clues regarding the underlying cause of AKI
Imaging studies - such as ultrasound, which may help assess kidney structure and identify possible abnormalities
Kidney biopsy - in selected cases, a small sample of kidney tissue may be examined under a microscope to better determine the cause of AKI

Risk factors

AKI is usually associated with another medical condition or health event. Factors that may increase the risk of developing AKI include:

Chronic kidney disease (CKD) or pre-existing kidney problems
Older age, although AKI can also occur in children
Hospitalisation, particularly for severe illnesses requiring intensive care
Peripheral artery disease, which involves the narrowing or blockage of blood vessels in the arms or legs
Diabetes, especially when poorly controlled
High blood pressure
Heart failure
Liver disease
Certain types of cancer and cancer treatments

Treatment

The treatment of AKI depends on its underlying cause, making early identification of the cause essential. Common treatment approaches may include:

Discontinuing medications that may be causing or worsening AKI
Providing fluids either orally or intravenously
Administering antibiotics if a bacterial infection is responsible
Inserting a urinary catheter to drain the bladder when AKI is caused by urinary blockage
Dialysis in cases of severe kidney damage or when other organs are affected

In many cases, dialysis is required only temporarily until kidney function improves. Most individuals with AKI require hospitalisation for close monitoring and treatment.

Complications

AKI may lead to several complications, including:

Fluid accumulation, which may cause shortness of breath due to fluid buildup in the lungs
Chest pain caused by inflammation of the pericardium, the membrane surrounding the heart
Muscle weakness resulting from imbalance of electrolytes and body fluids
Permanent kidney damage, which in some cases may progress to end-stage renal disease requiring lifelong dialysis or kidney transplantation
Death, particularly when kidney function stops completely and severe complications develop

Prevention

The risk of AKI may be reduced by maintaining good kidney health and managing underlying conditions appropriately. Preventive measures include:

Seeking prompt treatment for severe infections
Working closely with healthcare professionals to manage chronic conditions such as kidney disease, diabetes, and high blood pressure, which can increase the risk of AKI
Consulting healthcare providers to ensure that prescribed medications are safe for the kidneys, especially in individuals with kidney disease risk factors
Carefully following label instructions when using over-the-counter pain medications such as aspirin, acetaminophen, ibuprofen, and naproxen sodium, as excessive use may increase the risk of kidney injury
Maintaining a healthy lifestyle through regular physical activity, a balanced diet, and moderate alcohol consumption if alcohol is consumed

Prognosis

Most cases of prerenal AKI recover completely when the underlying cause is identified and treated early. However, if the underlying condition persists, it may progress to acute tubular necrosis (ATN), where kidney damage may not be fully reversible. Recurrent episodes of AKI can also contribute to the gradual deterioration of kidney function over time. Therefore, close monitoring is important until kidney function returns to normal or stabilises at a new baseline level.

The in-hospital mortality rate associated with AKI is approximately 40% to 50%, while mortality among patients admitted to intensive care units exceeds 50%. Several factors may influence prognosis, including:

Advanced age
Longer duration of illness
Fluid imbalance
Use of diuretics
Oliguria (reduced urine output)
Hypotension
Requirement for inotropic support
Involvement of multiple organs
Sepsis
Higher number of blood transfusions

Myths and Facts

Myth

AKI always progress to CKD

Fact

AKI is a sudden decline in kidney function, often occurring during serious illness, and although most patients recover, it can sometimes lead to CKD, while existing CKD may also increase the risk of AKI

Myth

AKI occurs only in older adults

Fact

Although older age increases the risk, AKI can affect anyone and may be triggered by trauma, infections, or reactions to anti-inflammatory medications

Myth

Kidney failure will always cause pain

Fact

AKI is often silent in the early stages, with symptoms like reduced urine output, swelling, or fatigue occurring even without pain

Frequently asked questions

How is AKI diagnosed?

AKI is usually suspected after recent illness, dehydration, surgery, low urine output, or low blood pressure, and is confirmed through blood tests showing raised creatinine levels and urine tests detecting blood or protein.

Can AKI be worsened by medications?

Yes, medicines such as non-steroidal anti-inflammatory drugs’ (NSAIDs), blood pressure drugs, diuretics, and certain toxic medications can worsen AKI and may need to be temporarily stopped during illness.

Will kidney damage from AKI be permanent?

Mild AKI often improves completely with prompt treatment, but severe AKI or pre-existing CKD may lead to lasting kidney damage.