Acute Kidney Injury in the Hospital Setting-Slides

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This presentation by Dr. Jose Manuel Monroy Trujillo focuses on Acute Kidney Injury (AKI) in hospitalized patients, emphasizing its epidemiology, definitions, causes, diagnosis, and consequences.<br /><br />Epidemiologically, AKI affects around 20-31.7% of hospitalized patients, with higher incidence in ICU settings (33%). Causes differ by region: in high-income countries, AKI often results from surgery, sepsis, diagnostic procedures, or iatrogenic factors; in low-income countries, additional factors include sepsis, volume depletion, toxins, and pregnancy. AKI is defined by KDIGO criteria based on increases in serum creatinine and/or decreased urine output, with stages 1-3 indicating severity. AKI lasting beyond 7 days but less than 90 is termed Acute Kidney Disease (AKD), and persistence beyond 90 days with reduced kidney function or albuminuria defines Chronic Kidney Disease (CKD).<br /><br />AKI can lead to chronic kidney disease and diminished renal reserve, affecting kidney lifespan significantly. Pathophysiology involves prerenal (e.g., volume depletion, heart failure), intrinsic (e.g., tubular injury, glomerulonephritis, drug-induced), and postrenal causes (e.g., obstruction). Common nephrotoxic medications causing AKI include aminoglycosides, NSAIDs, ACE inhibitors/ARBs, and immune checkpoint inhibitors (ICPi) used in cancer therapy, which can cause immune-mediated interstitial nephritis.<br /><br />Urinalysis and urine microscopy are essential tools in AKI evaluation. Urinalysis can detect abnormalities like proteinuria, hematuria, and casts, aiding in identifying causes such as glomerulonephritis or interstitial nephritis. The role of intravenous contrast in AKI remains controversial, with recent studies suggesting low risk for AKI from contrast exposure.<br /><br />A clinical case illustrates ICPi-associated AKI: a 77-year-old man with mesothelioma developed AKI during treatment, diagnosed with acute interstitial nephritis on biopsy, treated with corticosteroids but requiring discontinuation of immunotherapy.<br /><br />Consequences of AKI include medication dosing challenges, need for renal replacement therapy, and complications like hepatorenal syndrome and cardiorenal syndrome. Careful fluid management and medication monitoring are critical.<br /><br />Key takeaways: AKI is common in hospitalized settings, multiple medications can induce AKI, checkpoint inhibitors pose a delayed risk, urine studies are vital for diagnosis, sometimes requiring kidney biopsy, and vigilant fluid and medication management improves outcomes.

Keywords

Acute Kidney Injury

AKI epidemiology

KDIGO criteria

Acute Kidney Disease

Chronic Kidney Disease

nephrotoxic medications

immune checkpoint inhibitors

urinalysis in AKI

acute interstitial nephritis

renal replacement therapy