Monday, October 20, 2014

Basics of Renal Failure and Acute Kidney Injury


Acute kidney injury (AKI), previously known as acute renal failure, is a rapid reduction in kidney function that can represent a spectrum of injuries that involve failure to maintain fluid, electrolyte and acid-base balances. A variety of patients suffering from a variety of medical conditions can develop AKI. Patients with urological issues often experience AKI as a result of their disease, or occasionally treatments thereof. This blog will review the basics of AKI for urological patients.

Acute Kidney Injury Definitions

The hallmark of AKI is a rising creatinine value in the blood. Creatinine is a protein byproduct of muscle metabolism created at a constant rate by each individual and filtered by the kidneys at a constant rate. Decreases in kidney function lead to a rise in serum creatinine values (as the protein is not being released into the urine as readily). In general, a normal creatinine value for the average person is 1mg/dL and a 50% decrease in the filtering ability of the kidney results in a doubling of serum creatinine (see figure).


Campbell-Walsh Urology, 10th edition. Chapter 3: Evaluation of the Urologic Patient:
History, Physical Examination, and Urinalysis

The basic features of AKI are a rising serum creatinine and decreasing urine output. A number of stringent definitions have been created by nephrologists and other physicians to identify and risk-stratify patients with AKI. One such definition, created by the KDIGO (Kidney Disease: Improving Global Outcomes Research Group)[1] includes any of the following:
  • An increase in serum creatinine of 0.3mg/dL or greater in a 48 hour period
  • An increase in serum creatinine from baseline of 1.5x or greater within a week's time period
  • Urine volume <0.5mL/kg/hour for 6 hours


Acute Kidney Injury Incidence

It is estimated that 2-5% of all patients admitted to a medical or surgical hospital unit have or will develop AKI. That number increases to 36% of ICU (Intensive Care Unit) patients, of whom 20% will progress to need renal replacement therapy (i.e. dialysis).[2]

For urological patients, many surgeries affect the urinary system and kidney surgeries have an important influence on short- and long-term kidney function. The incidence of AKI following partial nephrectomy (removing a portion of the kidney involving a tumor) is approximately 3.6%. However, looking at patients with normal pre-operative renal function, the incidence of AKI is less than 1%. For patients with existing renal disease, the risk of AKI rises from 6.2% (if CKD, chronic kidney disease, stage 3) to 34% (CKD stage 4).[3]

It should be mentioned that a rising creatinine after surgery is very different from a rising creatinine due to a medical illness or injury. Future blogs will address this important distinction.

 

Implications of Acute Kidney Injury 

AKI often results from a transient insult to the kidneys and will recover when that insult is corrected or treated (a future blog will cover the common causes of AKI). Most patients will recover from AKI without any residual or long-term deficits in kidney function or health. However, according to one study, an increase of 0.5mg/dL in serum creatinine can result in:
  • 6.5 fold increase in odds of death
  • 3.5 day increase in length of stay
  • $7500 in excess hospital costs [3]
Therefore, prevention and awareness of AKI are important considerations for patients undergoing urological surgery. Stay tuned for future blogs regarding kidney failure as it relates to urologic patients.

 


 

[1] KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International Supplements. VOLUME 2 | ISSUE 1 | MARCH 2012. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf

[2] Ostermann M and Chang RS. Crit Care Med 2007; 35 (8): 1837-43.
[3] Lane BR, Babineau DC, Poggio ED et al. Factors predicting renal functional outcome after partial nephrectomy. J Urol 2008; 180 (6): 2363-2369.
[4] Chertow GM et al. J Am Soc Nephrol 2005; 16 (11): 3365-3370.

8 comments:

  1. This comment has been removed by a blog administrator.

    ReplyDelete
    Replies
    1. Herpes is a serious and recurring disease which can't be cured through drugs or injections by the American doctors but the best way to deal with Herpes is by taking natural herbs medicine for it, I have read about DR OKOSUN the great herbalist doctor who cure me from herpes with his powerful herbal medicine. i contacted him to know how he can help me and he told me never to worry
      that he will help me with the natural herbs from God!
      after 2 days of contacting him, he told me that the cure has been ready and
      he sent it to me via UPS SPEED POST and it got to me after 3 days!
      i used the medicine as he instructed me (MORNING and EVENING) and i was
      cured!
      its really like a dream but i am so happy! for the people suffering from the following diseases, Cancer, hypothyroidism, Herpes, COPD, HIV, Arthritis, Hpv, Infections,Liver Disease, Autoimmune Diseases, Parkinson's disease,Lupus and more should contact him for his herbal medicine because i am a living testimony and i was cured of herpes and his medicine is legit. i sent him what he requested and he sent me his medicine which i took for 3 good weeks and today am out here with negative result. when i went for test i was so happy after going through his medication. you can reach him through his email drokosun55@gmail.com or  whatsapp number:+2348124363791  

      Delete
  2. Thanks for the informative blog.If you are having trouble getting your medications without prescriptions, we are here to provide
    you with the solution.Buy Pain Relievers Online

    ReplyDelete
  3. Dr. Miracle Herbal Medicine Is A Good Remedy For Herpes, I Was A carrier of Herpes and I saw a testimony on how Dr. Miracle, cure Herpes, I decided to contact him, I contacted him and he guided me. I asked him for solutions and he started the remedies for my health. After he finish casting the spell, he told me to go for check up, could you believe that i was confirm herpes negative after the test, and i went to a different hospital and it was also negative, i am so happy today because i'm free from herpes disease with the help of Dr. Miracle. Thank God, now everything is fine, I'm cured by Dr.Miracle,herbal medicine, I'm very thankful to Dr. Miracle, Reach Him On (MiracleSpellHome@yahoo.com) Or WhatApp Him Or Call: +39(349)549- 4143,,, DOCTOR MIRACLE CAN AS WELL CURE THE FOLLOWING DISEASE:- (1). HERPES( 2). HIV/AIDS (3). CANCER ALL KINDS (4). Hepatitis A,B,C (5)Pregnant (6) Penis Enlargement ,,,,

    ReplyDelete
  4. Thanks for great health remedies. I am a kidney specialist in telangana and nice to read your blog posts. I really impressed with your remedies. really great work.

    kidney dialysis treatment in Telangana
    renal transplantation doctor in Telangana
    renal biopsy specialtist in Telangana
    CAPD specialist Telangana
    paediatric nephrologist in Telangana

    Mobile or Whatsapp +91 924 770 1326

    ReplyDelete

  5. BEST TRADITIONAL HERBAL CURE FOR KIDNEY DISEASE AND CANCER .Hi Friends i am so glad to write this article today to tell the
    world how my KIDNEY DISEASE was cured,i have been detected with kidney disease (CKD), ever since then my life has
    been in complete bizarre and agony,i have used so many
    drugs that was prescribed to me by several doctors,but it
    didn't cure my kidney disease (CKD) neither did it reduce the pain,until a
    certain day i was checking for solution in the internet,then
    miraculously came across Dr. Edidia the powerful herbalist
    that cure numerous individuals KIDNEY DISEASE AND CANCER then i
    contacted his email:
    ( dredidiaherbalhome@gmail.com and his what'sap number +2349074505296) i explained everything to
    him and prepared a cure and send it to me that cure my kidney disease totally
    after receiving his herbal medicine, he also cure my friend from CANCER DISEASE so my friends viewer
    so why wait and suffer when there is someone like Dr Edidia
    that can cure any disease kidney disease, hpv, als, Cardiovascular disease (CVD), Coronary heart disease, herpes, how, cancer.
    you can contact via email:
    ( dredidiaherbalhome@gmail.com) or whatsapp him.
    +2349074505296
    his website http://dredidiaherbalhome.weebly.com/
    https://dr-edidia-herbal-home.business.site/

    ReplyDelete
  6. Herpes is a serious and recurring disease which can't be cured through drugs or injections by the American doctors but the best way to deal with Herpes is by taking natural herbs medicine for it, I have read about DR OKOSUN the great herbalist doctor who cure me from herpes with his powerful herbal medicine. i contacted him to know how he can help me and he told me never to worry
    that he will help me with the natural herbs from God!
    after 2 days of contacting him, he told me that the cure has been ready and
    he sent it to me via UPS SPEED POST and it got to me after 3 days!
    i used the medicine as he instructed me (MORNING and EVENING) and i was
    cured!
    its really like a dream but i am so happy! for the people suffering from the following diseases, Cancer, hypothyroidism, Herpes, COPD, HIV, Arthritis, Hpv, Infections,Liver Disease, Autoimmune Diseases, Parkinson's disease,Lupus and more should contact him for his herbal medicine because i am a living testimony and i was cured of herpes and his medicine is legit. i sent him what he requested and he sent me his medicine which i took for 3 good weeks and today am out here with negative result. when i went for test i was so happy after going through his medication. you can reach him through his email drokosun55@gmail.com or  whatsapp number:+2348124363791  

    ReplyDelete