Acute kidney injury natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Certain forms of AKI such as contrast induced nephropathy, usually have a shorter course with creatinine peak in 3-5 days. Common complications of acute kidney injury include anemia, metabolic acidosis, anorexia, nausea and vomiting. In general, the majority of patients that survive the initial insult recover their kidney function within 30 days.

Natural History, Complications, and Prognosis

Natural History

  • Certain forms of AKI such as contrast induced nephropathy, usually have a shorter course with creatinine peak in 3-5 days.[1]

Complications

Prognosis

  • Acute interstitial nephritis causing AKI can have a variable course, sometimes resolving with the withdrawal of the inciting agent and at times requiring several weeks to restore full renal function.
  • Other forms related to a more severe systemic illness such as DIC, lupus, and RPGN often result in end-stage renal disease.[6]
  • In general, the majority of patients that survive the initial insult recover their kidney function within 30 days.[6]
  • Beyond two months, patients usually will not recover their full renal function but might have some improvement that allows them to be free of renal replacement therapy.[7][8]
  • Despite the natural history showing possible recovery of renal function, AKI is associated with high mortality.
  • AKI is also associated with increased length of hospital stay and costs.[1]

References

  1. 1.0 1.1 Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005). "Acute kidney injury, mortality, length of stay, and costs in hospitalized patients". J Am Soc Nephrol. 16 (11): 3365–70. doi:10.1681/ASN.2004090740. PMID 16177006.
  2. Vandijck DM, Reynvoet E, Blot SI, Vandecasteele E, Hoste EA (2007). "Severe infection, sepsis and acute kidney injury". Acta Clin Belg. 62 Suppl 2: 332–6. PMID 18283994.
  3. Faubel S (July 2008). "Pulmonary complications after acute kidney injury". Adv Chronic Kidney Dis. 15 (3): 284–96. doi:10.1053/j.ackd.2008.04.008. PMID 18565479.
  4. White LE, Hassoun HT, Bihorac A, Moore LJ, Sailors RM, McKinley BA, Valdivia A, Moore FA (September 2013). "Acute kidney injury is surprisingly common and a powerful predictor of mortality in surgical sepsis". J Trauma Acute Care Surg. 75 (3): 432–8. doi:10.1097/TA.0b013e31829de6cd. PMC 3823059. PMID 24089113.
  5. Doyle JF, Forni LG (October 2015). "Long-Term Follow-up of Acute Kidney Injury". Crit Care Clin. 31 (4): 763–72. doi:10.1016/j.ccc.2015.06.017. PMID 26410143.
  6. 6.0 6.1 Kjellstrand CM, Gornick C, Davin T (1981). "Recovery from Acute Renal Failure". Renal Failure. 5 (1): 143–61. doi:10.3109/08860228109076011.
  7. Bagshaw SM (2006). "Epidemiology of renal recovery after acute renal failure". Curr Opin Crit Care. 12 (6): 544–50. doi:10.1097/01.ccx.0000247444.63758.0b. PMID 17077684.
  8. Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA; et al. (2009). "Acute kidney injury increases risk of ESRD among elderly". J Am Soc Nephrol. 20 (1): 223–8. doi:10.1681/ASN.2007080837. PMC 2615732. PMID 19020007.

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