SHM's Clinical Quick Talks-Acute Kidney Injury

Pdf Summary

The document "Acute Kidney Injury" by Jennifer K. Readlynn, MD, discusses the identification and assessment of Acute Kidney Injury (AKI). The article emphasizes that AKI is characterized by an increase in serum creatinine (Cr) by 0.3 mg/dL within 48 hours or a 1.5x increase from baseline within seven days, alongside reduced urine output.<br /><br />Key learning points include identifying initial tests to determine the cause of AKI and differentiating between high and low-value tests. AKI causes include pre-renal issues (e.g., volume depletion, ACE/ARB use), intrinsic renal issues (e.g., acute tubular necrosis, glomerulonephritis), and post-renal obstructions (e.g., bladder compression).<br /><br />The initial workup includes a comprehensive history, focusing on symptoms like vomiting, diarrhea, and recent medication use, and a physical exam to assess for volume changes. Labs such as urinalysis help identify potential intrinsic causes (e.g., WBCs might indicate acute interstitial nephritis).<br /><br />The article warns against unnecessary tests like FeNa/FeUrea and urine eosinophils, which may not provide more insight than a physical exam in non-oliguric patients. Renal ultrasound is suggested only if no improvement is seen after initial treatments.<br /><br />It highlights nephrotoxins commonly implicated in AKI, including NSAIDs and vancomycin. It also touches on drugs like ACE/ARB, which increase AKI vulnerability, and clarifies that CT contrast is not proven to cause AKI.<br /><br />Clinical pearls stress the risk of developing chronic kidney disease after an AKI incident, and the predominance of pre-renal and post-renal causes suggests that fluid resuscitation and catheterization resolve many cases.<br /><br />High-value resources include academic articles and a podcast episode for deeper exploration of AKI myths and best practices. The document was last updated in June 2025.

Asset Subtitle

Jennifer Readlynn

Keywords

Acute Kidney Injury

serum creatinine

urine output

pre-renal issues

intrinsic renal issues

post-renal obstructions

nephrotoxins

renal ultrasound

chronic kidney disease

fluid resuscitation