Internal Medicine

Biography

Biography: Khalil Ahmed

Abstract

Acute kidney injury (AKI) is defined as rapid reduction in kidney functions resulting in failure to maintain fluid, electrolyte and acid-base homeostasis. AKI is reported to occur in 15-20 % of all ICU patients and approximately 5% of them may require dialysis during ICU stay. Typically patients with AKI develop oliguria or anuria and may present signs & symptoms of fluid overload. Oliguria is defined as if urine output < 1ml/kg/hour in infants, and < 0.5ml/kg/hour in children & adults for consecutive 6 hours. While, anuria is defined as urine output < 50ml/24 hours in adult patients. Broadly speaking AKI is classified into pre-renal, renal & post-renal depending upon the initial insult leading to AKI. Among them pre-renal is the most common cause of AKI, approximately 55-90% in the ICU setting. Renal causes like acute vasculitis, interstitial nephritis, contrast nephropathy, severe rhabdomyolysis are also contributing to a small proportion of these patients. Post-renal causes accounts < 5% of all others. The main stay of management of AKI depends upon early recognition & early diagnosis of renal insults. To diagnose AKI, these is wide range of investigations, but recently some new biomarkers have been identified which pretty help to identify early onset of AKI. Among these biomarkers, neutrophil gelatinase associated lipocalin (NGAL) has been identified in early diagnosis of AKI due to cardiopulmonary bypass, contrast induced nephropathy, AKI due to sepsis, early recognition of AKI after renal transplant. Some other biomarkers also have been identified for diagnosis of early AKI like, IL 18, KIM 1, Cystacin C and L-FABP. The initial management step of AKI is to treat the offending factors leading to renal impairment, e.g, treating dehydration and sepsis, stopping offending drugs like NSAIDS, aminoglycosides & ACE inhibitors, well rehydration before & after intravenous contrast agents to prevent contrast induced nephropathy. A quite fair number of patients end up requiring dialysis and continuous renal replacement therapy (CRRT) is the most effective method for dialysis in these patients. It may improve survival rate by 30%. There is large debate about early vs late start of CRRT. But, all depends upon the clinical judgment and other associated parameters to make decision to start early CRRT in these patients. About 10% of all AKI patients may require chronic dialysis and further follow up. So, AKI is one of the serious problem in intensive care, its early recognition and management has a vital role in the management of critically ill patients.