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:
Overview
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis
Natural History
The outcomes of AKI vary greatly based on the population studied, the etiology of AKI, and the supportive therapy used. Certain forms of AKI such as contrast induced nephropathy, usually have a shorter course with creatinine peak in 3-5 days and resolution within 1-2 weeks.[1] 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. In general, the majority of patients that survive the initial insult recover their kidney function within 30 days.[2] 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. The latter represents a very small proportion of patients, particularly elderly patients, and patients with pre-existing CKD. [3][4]
However, despite the natural history showing possible recovery of renal function, AKI is associated with high mortality. In general, mortality in AKI is highly correlated with the 3 AKI stages, with higher stages increasing the risk of death. In a population based study by Ali et al, 6-month mortality after AKI was 46% in RIFLE stage R, 48% in stage I, and 56 in stage F.[5] In hospitalized patients mortality after AKI ranged from 8.8%[6] to 29.2%[7] in stage R and from 26.3%[6] to 66.7%[8] in stage F. Probably the most studied cause of AKI, contrast nephropathy, has given a lot of insight on the mortality with AKI. Levy et al showed that the mortality rate in patients undergoing contrast procedures was 5 fold higher if their post-procedural course was complicated by AKI.[9]
Studies have substantiated the association of AKI with poor prognosis not only in terms of mortality. A meta-analysis of studies with long-term AKI follow up showed independent association of AKI with MI and congestive heart failure.[10][11] AKI is also associated with ESRD especially in patients with higher stages requiring hemodialysis. The Acute Renal Failure Trials Network (ATN) study showed that patients on hemodialysis after AKI had only a 50% chance of recovering their kidney function after 28 days. [12]
AKI is also associated with increased length of hospital stay and costs. A study by Ishani et al showed that small increases in serum creatinine (≥0.5 mg/dl) were associated with a 6.5-fold higher mortality, a 3.5 day increase in length of stay, and around $7500 in added costs.[13]
Complications
- Common complications of acute kidney injury include:[14][15][16][17]
- Anemia
- Anorexia
- Nausea and vomiting
- Upper gastrointestinal bleeding
- Metabolic acidosis
- Hyperkalemia
- Pulmonary edema
- Hyperphosphatemia
- Risk of infectios disease
Prognosis
References
- ↑ Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF; et al. (1995). "Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study". Kidney Int. 47 (1): 254–61. PMID 7731155.
- ↑ Kjellstrand CM, Gornick C, Davin T (1981). "Recovery from Acute Renal Failure". Renal Failure. 5 (1): 143–61. doi:10.3109/08860228109076011.
- ↑ 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.
- ↑ 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.
- ↑ Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W; et al. (2007). "Incidence and outcomes in acute kidney injury: a comprehensive population-based study". J Am Soc Nephrol. 18 (4): 1292–8. doi:10.1681/ASN.2006070756. PMID 17314324.
- ↑ 6.0 6.1 Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D; et al. (2006). "RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis". Crit Care. 10 (3): R73. doi:10.1186/cc4915. PMC 1550961. PMID 16696865.
- ↑ Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W; et al. (2009). "Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database". Intensive Care Med. 35 (10): 1692–702. doi:10.1007/s00134-009-1530-4. PMID 19547955 Check
|pmid=value (help). - ↑ Fang Y, Ding X, Zhong Y, Zou J, Teng J, Tang Y; et al. (2010). "Acute kidney injury in a Chinese hospitalized population". Blood Purif. 30 (2): 120–6. doi:10.1159/000319972. PMID 20714143.
- ↑ Levy EM, Viscoli CM, Horwitz RI (1996). "The effect of acute renal failure on mortality. A cohort analysis". JAMA. 275 (19): 1489–94. PMID 8622223 Check
|pmid=value (help). - ↑ Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR (2009). "Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis". Am J Kidney Dis. 53 (6): 961–73. doi:10.1053/j.ajkd.2008.11.034. PMC 2726041. PMID 19346042.
- ↑ Coca SG, Singanamala S, Parikh CR (2012). "Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis". Kidney Int. 81 (5): 442–8. doi:10.1038/ki.2011.379. PMC 3788581. PMID 22113526.
- ↑ VA/NIH Acute Renal Failure Trial Network. Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST; et al. (2008). "Intensity of renal support in critically ill patients with acute kidney injury". N Engl J Med. 359 (1): 7–20. doi:10.1056/NEJMoa0802639. PMC 2574780. PMID 18492867. Review in: ACP J Club. 2008 Nov 18;149(5):6
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.