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AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body.
AKI can also affect other organs such as the brain, heart, and lungs. Acute kidney injury is common in patients who are in the hospital, in intensive care units, and especially in older adults.
In some cases, AKI causes no symptoms and is only found through other tests done by your healthcare provider. Some disease and conditions can damage your kidneys and lead to AKI.
Some examples include:. In some people, conditions or diseases can block the passage of urine out of the body and can lead to AKI. Depending on the cause of your acute kidney injury, your healthcare provider will run different tests if he or she suspects that you may have AKI.
CC-BY 4. The New England Journal of Medicine. Emergency Medicine Journal. Archived from the original on 8 August Retrieved 8 August Intensive Care Medicine.
Scientific Reports. Bibcode : NatSR Joseph; Bihorac Azra Kidney International. Archived from the original on Retrieved Philadelphia: Saunders.
August Most Frequent Conditions in U. Hospitals, September Hospitals, ". Kidney International Review. Br Med J. Kidney disease. See Template:Glomerular disease.
Renal tubular acidosis proximal distal Acute tubular necrosis Genetic Fanconi syndrome Bartter syndrome Gitelman syndrome Liddle's syndrome. Interstitial nephritis Pyelonephritis Balkan endemic nephropathy.
Renal artery stenosis Renal ischemia Hypertensive nephropathy Renovascular hypertension Renal cortical necrosis. Organ failure. Multiple organ dysfunction syndrome.
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Wikimedia Commons. Acute kidney injury AKI is a major health concern, because AKI is related with an increase in morbidity and mortality.
Anemia is related to AKI in several clinical settings. However, the relationship between anemia and AKI and the effect of anemia on long-term mortality are unresolved in critically ill patients.
Clinical approach to the diagnosis of acute renal failure. Primer on Kidney Diseases. Philadelphia, Pa. Approximately 70 percent of community-acquired cases of acute kidney injury are attributed to prerenal causes.
Autoregulatory mechanisms often can compensate for some degree of reduced renal perfusion in an attempt to maintain the glomerular filtration rate.
In patients with preexisting chronic kidney disease, however, these mechanisms are impaired, and the susceptibility to develop acute-on-chronic renal failure is higher.
Several medications can cause prerenal acute kidney injury. Notably, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can impair renal perfusion by causing dilation of the efferent arteriole and reduce intraglomerular pressure.
These drugs and others limit the normal homeostatic responses to volume depletion and can be associated with a decline in renal function.
In patients with prerenal acute kidney injury, kidney function typically returns to baseline after adequate volume status is established, the underlying cause is treated, or the offending drug is discontinued.
Intrinsic renal causes are also important sources of acute kidney injury and can be categorized by the component of the kidney that is primarily affected i.
Acute tubular necrosis is the most common type of intrinsic acute kidney injury in hospitalized patients. The cause is usually ischemic from prolonged hypotension or nephrotoxic from an agent that is toxic to the tubular cells.
In contrast to a prerenal etiology, acute kidney injury caused by acute tubular necrosis does not improve with adequate repletion of intravascular volume and blood flow to the kidneys.
Both ischemic and nephrotoxic acute tubular necrosis can resolve over time, although temporary renal replacement therapy may be required, depending on the degree of renal injury and the presence of preexisting chronic kidney disease.
Glomerular causes of acute kidney injury are the result of acute inflammation of blood vessels and glomeruli.
Glomerulonephritis is usually a manifestation of a systemic illness e. History, physical examination, and urinalysis are crucial for diagnosing glomerulonephritis Table 3 9 and Figure 1 Because management often involves administration of immunosuppressive or cytotoxic medications with potentially severe adverse effects, renal biopsy is often required to confirm the diagnosis before initiating therapy.
Volume loss e. Dilated neck veins, S 3 heart sound, pulmonary rales, peripheral edema. Acute tubular necrosis.
History of receiving nephrotoxic medications including over-the-counter, illicit, and herbal , hypotension, trauma or myalgias suggesting rhabdomyolysis, recent exposure to radiographic contrast agents.
Lupus, systemic sclerosis, rash, arthritis, uveitis, weight loss, fatigue, hepatitis C virus infection, human immunodeficiency virus infection, hematuria, foamy urine, cough, sinusitis, hemoptysis.
Medication use e. Nephrotic syndrome, trauma, flank pain, anticoagulation atheroembolic disease , vessel catheterization or vascular surgery.
Livedo reticularis, funduscopic examination showing malignant hypertension , abdominal bruits. Urinary urgency or hesitancy, gross hematuria, polyuria, stones, medications, cancer.
Adapted with permission from Smith MC. Acute renal failure. Clinical Decisions in Urology. Acute interstitial nephritis can be secondary to many conditions, but most cases are related to medication use, making patient history the key to diagnosis.
In about one-third of cases, there is a history of maculopapular erythematous rash, fever, arthralgias, or a combination of these symptoms.
A kidney biopsy may be needed to distinguish between allergic interstitial nephritis and other renal causes of acute kidney injury.
In addition to discontinuing offending agents, steroids may be beneficial if given early in the course of disease.
Acute events involving renal arteries or veins can also lead to intrinsic acute kidney injury. Renal atheroembolic disease is the most common cause and is suspected with a recent history of arterial catheterization, the presence of a condition requiring anticoagulation, or after vascular surgery.
Physical examination and history provide important clues to the diagnosis Table 3 9. Vascular causes of acute kidney injury usually require imaging to confirm the diagnosis.
Postrenal causes typically result from obstruction of urinary flow, and prostatic hypertrophy is the most common cause of obstruction in older men.
Prompt diagnosis followed by early relief of obstruction is associated with improvement in renal function in most patients.
Clinical presentation varies with the cause and severity of renal injury, and associated diseases. Most patients with mild to moderate acute kidney injury are asymptomatic and are identified on laboratory testing.
Patients with severe cases, however, may be symptomatic and present with listlessness, confusion, fatigue, anorexia, nausea, vomiting, weight gain, or edema.
Other presentations of acute kidney injury may include development of uremic encephalopathy manifested by a decline in mental status, asterixis, or other neurologic symptoms , anemia, or bleeding caused by uremic platelet dysfunction.
The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function.
Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness. The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium FE Na.
Imaging studies can help rule out obstruction. Useful tests are summarized in Table 4. Elevated antineutrophil cytoplasmic antibody, antiglomerular basement membrane antibody.
Elevated creatine kinase level, elevated myoglobin level, dipstick positive for blood but negative for red blood cells. Evidence of hemolysis schistocytes on peripheral smear, decreased haptoglobin level, elevated indirect bilirubin level, elevated lactate dehydrogenase level.
Hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, systemic lupus erythematosus, other autoimmune diseases.
Malignancy, prostate hypertrophy, uterine fibroids, nephrolithiasis, ureterolithiasis. Adapted with permission from Agrawal M, Swartz R.
Acute renal failure [published correction appears in Am Fam Physician. Am Fam Physician. The definition of acute kidney injury indicates that a rise in creatinine has occurred within 48 hours, although in the outpatient setting, it may be hard to ascertain when the rise actually happened.
A high serum creatinine level in a patient with a previously normal documented level suggests an acute process, whereas a rise over weeks to months represents a subacute or chronic process.
Urinalysis is the most important noninvasive test in the initial workup of acute kidney injury. Findings on urinalysis guide the differential diagnosis and direct further workup Figure 1 The presence of acute hemolytic anemia with the peripheral smear showing schistocytes in the setting of acute kidney injury should raise the possibility of hemolytic uremic syndrome or thrombotic thrombocytopenic purpura.
In patients with oliguria, measurement of FE Na is helpful in distinguishing prerenal from intrinsic renal causes of acute kidney injury. FE Na is defined by the following formula:.
Online calculators are also available. A value less than 1 percent indicates a prerenal cause of acute kidney injury, whereas a value greater than 2 percent indicates an intrinsic renal cause.
In patients on diuretic therapy, however, a FE Na higher than 1 percent may be caused by natriuresis induced by the diuretic, and is a less reliable measure of a prerenal state.
In such cases, fractional excretion of urea may be helpful, with values less than 35 percent indicating a prerenal cause. FE Na values less than 1 percent are not specific for prerenal causes of acute kidney injury because these values can occur in other conditions, such as contrast nephropathy, rhabdomyolysis, acute glomerulonephritis, and urinary tract obstruction.The odds ratios (ORs) and hazard ratios for AKI and all-cause mortality were calculated after adjusting for multiple covariates. The OR of AKI increased depending on the decrease in hemoglobin level and the ideal threshold point of hemoglobin linked to increasing AKI risk was g/snarr-site.com by: Keunggulan Aki MF GS Astra Advantages of GS Astra MF Battery. Teknologi Aki MF untuk Iklim Tropis. Tangguh MF Battery Technology for Tropical Climate Tips membersihkan soket kelistrikan Tips to Clean Electricity Socket. Musim hujan yang datang bisa dianggap berkah, Here is some advices during rainy season. . G Force menawarkan kualitas dan harga terjangkau GFORCE. Terlengkap. Dicari karena mutunya Jaringan penjualan kami tersebar di seluruh wilayah Indonesia Produk GFORCE bebas perawatan dan aman digunakan TEKNOLOGI TERBAIK UNTUK AKI MOTOR ANDA Pertumbuhan sepeda motor di Indonesia semakin meningkat. Bush versprach daraufhin, weitere diplomatische Zwischenfälle zu vermeiden. Beschreibung Unwissentlich Sudoku App Kostenlos Ali G in ein Komplott verwickelt, das den britischen Premierminister und seine Regierung stürzen soll. Mark Mylod. Sacha Noam Baron Cohen ist ein britischer Komiker und Schauspieler, der besonders für die durch ihn verkörperten Figuren Ali G, Borat, Brüno und Admiral General Aladeen bekannt ist. Durch sexistische (Ali G, Borat) oder antisemitische (Borat, Aladeen) Figuren entlarvt Baron Cohen also auch solche Vorurteile bei seinen Interviewpartnern. Dies. Ali G in da House (Originaltitel: Ali G Indahouse) ist eine Filmkomödie aus dem Jahr Sacha Baron Cohen, der auch das Drehbuch schrieb, spielt darin. snarr-site.com - Kaufen Sie Ali G. In Da House günstig ein. Qualifizierte Bestellungen werden kostenlos geliefert. Sie finden Rezensionen und Details zu einer.
Aki G - InhaltsverzeichnisAugust Retrieved Download as PDF Printable version. These drugs and others limit the normal homeostatic responses to volume depletion and can be associated with a decline in renal function. Hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, systemic lupus erythematosus, other autoimmune diseases. Most Taxi Spiele Kostenlos with mild to moderate acute kidney injury are asymptomatic and are identified on laboratory testing. After acute kidney injury is established, management is primarily supportive. The initial workup includes a patient history to identify the use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or 50 Eur To Pln impair renal function. More in Pubmed Citation Related Articles. Acute kidney injury is associated with a high rate of adverse outcomes; mortality rates range between 25 and 80 percent, depending on the cause and the clinical Erfahrungen Lovepoint of the patient. History, physical examination, Cluedo Versionen urinalysis are crucial for diagnosing glomerulonephritis Table 3 9 and Figure 1 August