Acute
Kidney Injury (AKI), formerly known as acute renal failure, refers to a sudden
and rapid decline in kidney function. While most cases are managed medically,
surgical intervention becomes necessary in specific situations where conservative
approaches prove insufficient. Encompasses the abrupt impairment of renal function,
leading to a compromised capacity for blood filtration. Clinical manifestations
of acute kidney injury encompass dyspnea, fatigue, cognitive disorientation,
lower extremity oedema, and nausea.
Severity
of Acute Kidney Injury
- Clinical
Stages: AKI is
categorized into three clinical stages based on serum creatinine levels
and urine output. The severity progresses from Stage 1 (mild) to Stage 3
(severe).
- Potential Complications: Severe AKI can lead to
life-threatening complications such as electrolyte imbalances, fluid
overload, and metabolic acidosis. These complications underscore the
importance of timely medical evaluation.
Signs
and Symptoms of AKI
- Decreased
Urine Output: A
significant reduction in urine output, known as oliguria, may indicate
advanced stages of AKI. Anuria, where no urine is produced, is a critical
sign requiring urgent attention.
- Fluid Retention: Noticeable swelling in
the extremities, face, or abdomen due to fluid retention can be indicative
of worsening kidney function and necessitates prompt medical assessment.
- Symptoms of Uraemia: As AKI progresses,
symptoms such as nausea, vomiting, fatigue, confusion, and seizures may
arise, indicating a critical stage requiring immediate medical
intervention.
Urgent
Situations Requiring Medical Attention:
- Sudden
Onset: If AKI
develops suddenly, especially following trauma, severe infections, or
exposure to nephrotoxic substances, immediate medical attention is
imperative to determine the underlying cause and initiate appropriate
interventions.
- Severe Dehydration: Conditions leading to
severe dehydration, such as persistent vomiting, diarrhoea, or excessive
fluid loss, can trigger AKI. In such cases, seeking medical help promptly
is crucial to prevent further renal damage.
- Medication-Induced AKI: Certain medications
and contrast agents can precipitate AKI. If an individual experiences a
rapid decline in kidney function after medication use, seeking immediate
medical advice is essential.
Special
Considerations:
- Underlying Health Conditions: Individuals with
pre-existing conditions such as diabetes, hypertension, or chronic kidney
disease are at higher risk of developing AKI. Any noticeable changes in
kidney function should prompt a prompt medical evaluation.
- Postoperative Period: AKI can occur after
surgical procedures, especially in cases involving significant blood loss,
prolonged surgeries, or exposure to contrast agents. Vigilance in the
postoperative period is crucial, and any signs of AKI should be promptly
addressed.
When to Consult a Professional?
Persistent Symptoms:
If symptoms suggestive
of AKI persist, it is essential to consult a healthcare professional promptly.
Early diagnosis and intervention can significantly impact the prognosis.
High-Risk Populations:
Individuals at high risk
for AKI should maintain regular follow-ups with healthcare providers, and any
deviations from baseline kidney function should be promptly reported.
Recognizing the signs and severity of AKI
is paramount for timely intervention. Any suspicion of AKI or associated
symptoms should prompt an immediate consultation with a healthcare professional
to determine the underlying cause and initiate appropriate management
strategies. Early intervention can mitigate the progression of AKI and improve
overall outcomes.
Recommendation of Surgical Intervention in Acute
Kidney Injury
1. Obstructive
Uropathy
- Obstructive uropathy involves urinary tract blockage, impeding
urine flow and inducing AKI.
- Urological procedures, such as lithotripsy for calculi, or surgical
correction of anatomical anomalies, aim to restore unimpeded urine flow
and alleviate AKI.
2. Renovascular
Conditions
- Renovascular pathologies compromise renal blood supply,
precipitating AKI.
- Renovascular surgeries, including revascularization techniques, are
applied to rectify conditions like renal artery stenosis, preserving renal
perfusion and function.
3. Trauma and Injury
- Severe renal trauma can disrupt vasculature, leading to ischemic
injury and AKI.
- Urgent surgical exploration allows for the repair of traumatic
injuries, potentially averting irreversible renal damage and ameliorating
the course of AKI.
4. Infection-Related
Complications
- Infections causing renal abscesses may instigate AKI.
- Surgical drainage of abscesses and, in extreme cases, nephrectomy
may be warranted to control sepsis, mitigate AKI, and prevent systemic
dissemination.
5. Renal Vascular
Thrombosis
- The formation of intravascular clots compromises renal blood flow,
triggering AKI.
- Thrombectomy or vascular reconstruction procedures are employed to
restore vascular patency, alleviating ischemia-induced AKI.
Diagnose & Treatment of Acute
Kidney Injury
Clinical
Evaluation:
Conducting a thorough physical examination is imperative
for physicians to pinpoint the aetiology of acute kidney injury (AKI). An
enlarged bladder may signify urinary tract obstruction leading to
hydronephrosis.
Hematological
Analysis:
Diagnosis confirmation requires blood
tests quantifying creatinine and urea nitrogen levels. A progressive daily
elevation in creatinine serves as a pivotal indicator of AKI, reflecting the
severity of renal function decline.
Renal
Functional Assessment:
Creatinine levels function as the primary
gauge for the degree of kidney function deterioration. Higher creatinine levels
correlate with more pronounced declines in renal function.
Metabolic
Profiling:
Additional blood tests discern metabolic
imbalances associated with severe kidney function decline, encompassing
acidosis (indicating low bicarbonate levels), hyperkalemia (elevated
potassium), hyponatremia (reduced sodium), hypocalcemia (low calcium), and
hyperphosphatemia (high phosphorus).
Urological
Investigations:
Urine tests, including urinalysis and
electrolyte measurement (sodium, potassium, calcium, phosphate), aid in
differentiating causes of kidney injury, such as inadequate blood flow, renal
damage, or urinary obstruction.
Medical
Imaging:
Utilizing ultrasonography or computed
tomography (CT) facilitates kidney imaging, identifying hydronephrosis or an
enlarged bladder. X-rays with angiography may be employed in cases where blood
vessel obstruction is suspected. However, due to the iodine-containing contrast
agent's potential for additional kidney damage, angiography is reserved for
situations where alternative tests yield insufficient information.
Magnetic
Resonance Angiography (MRA):
MRA, akin to angiography, provides
comparable information. Traditional gadolinium use in MRA may pose risks in
individuals with severely reduced kidney function, leading to nephrogenic
fibrosing dermopathy. However, newer gadolinium formulations mitigate this
risk, making MRA a viable option after consultation with the healthcare team.
Diagnostic
Biopsy:
In instances where other diagnostic
approaches fall short, a biopsy may be essential to ascertain both the
diagnosis and prognosis of kidney injury.
Criteria
for Surgical Consideration at Link Hospital
- Therapeutic Resistance: When conventional
medical interventions, encompassing volume resuscitation and
pharmacotherapy, prove inadequate in reversing AKI, surgical exploration
becomes imperative.
- Emergent Circumstances: Traumatic incidents,
profound infections, or swiftly progressing pathologies may necessitate
emergent surgical measures to preclude irreversible renal compromise.
- Structural
Abnormalities:
Identifiable anatomical irregularities, such as obstructive lesions or
vascular anomalies, demand surgical correction to rectify underlying
issues contributing to AKI.
As a forefront institution in renal
care, Link Hospital actively engages in cutting-edge research and innovation.
This commitment to advancing medical and surgical knowledge translates into
enhanced care options for our patients, keeping us at the forefront of AKI
treatment modalities.
Surgical involvement in AKI management is contingent upon discerning clinical factors,
including etiological considerations, therapeutic responsiveness, and the
urgency of intervention. Surgeons play a pivotal role in addressing the
anatomical substrates of AKI, mitigating the course
of the condition, and optimizing patient outcomes through meticulous and
tailored surgical approaches. Decisions for surgical interventions are guided
by a nuanced understanding of the multifaceted factors underpinning AKI
presentations.
Link Hospital distinguishes itself as the preferred choice
for AKI treatment, blending cutting-edge medical expertise, state-of-the-art
infrastructure, and a patient-centric ethos. Our commitment to excellence in
both medical and surgical realms positions us as a leading institution in the
realm of renal care.