Objective Acute kidney injury Know about definition of Acute kidney injury Function of kidney Sign and symptoms of AKI Know about Risk factor of AKI Understand about complication of AKI Contents: Introduction Of Acute kidney injury Physiology Of Acute kidney injury Pathophysiology Of Acute kidney injury Clinical feature Of Acute kidney injury Risk Factor Of Acute kidney injury Diagnosis Of Acute kidney injury Differential diagnosis Of Acute kidney injury Complication Of Acute kidney injury Management Of Acute kidney injury

1. Physiopathology
Acute Kidney Injury
Students : 1. Cheng Chanroth , 2. Khlok Sokuntheara , 3. Shoeng Rany
4. Thak Sokhamony, 5. Kun Salim
Professor : Im Bunthoeun

2. Objective
 Know about definition of Acute kidney injury
 Function of kidney
 Sign and symptoms of AKI
 Know about Risk factor of AKI
 Understand about complication of AKI

3. Contents:
I. Introduction
II. Physiology
III. Pathophysiology
IV. Clinical feature
V. Risk Factor
VI. Diagnosis
VII. Differential diagnosis
VIII. Complication
IX. Management

4. I. Introduction
1. Definition
 Acute kidney injury (AKI), Previously known as acute renal failure
(ARF), is an acute decline in renal function, leading to a rise in serum
creatinine and/or a fall in urine output.

5. 2. Epidemiology
 In US, the total number of hospitalization for AKI increased from 953,926 in
2000 to 3,959,560 in 2014.
 In UK, incidence range from 172 per million population per year up to 630 per
million population per year.
 Overall, in cidence of AKI among hospitalized patient range from 13% to 22%.

6. III. Physiology

7. II. Physiology
1. Excretory function
a. Metabolic
b. Drug
c. Toxins
2. Homeostatic functions
a. Maintained of water balance
b. Maintained of electrolyte balance
c. Maintained of acid-base balance

8. 3. Endocrine functions
a. Erythropoietin
b. 1.25 – Dihydroxycholecalciferol
c. Renin

9.  Etiologies of AKI
 Renal hypoperfusion (Pre renal)
 Disorders involving the renal parenchymal (intra renal)
 Disorders with acute urinary tract obstruction (post renal)
III. Pathophysiology

10. III. Pathophysiology

11. IV. Clinical feature
 The mitral symptom
 Fatigue
 Malaise
 Loss of ability to excrete water, salt and waste via kidney.

12.  Clinical Manifestations
 Pre renal: Decreased tissue turgor, dryness of mucous membrane,
weight loss, hypotension, oliguria or anuria, tachycardia.
 Post renal: Obstruction to urine flow, nephrolithiasis, obstructive
symptoms of BPH.
 Intra renal: Edema, presentation based on cause.
 Changes in urine vol. And serum conc. Of BUN, creatinine, potassium
and so forth..

13. V. Risk Factors
 Advanced age
 Diabetes mellitus
 Sodium-retaining states(Congestive heart failure, Cirrhosis,
Nephrotic syndrome).
 Sepsis
 Drug overdose.

14. 1. History & Physical Examination
 History:
 Age
 Reduced urine production
 Vomiting
 Diarrhea
 Hemorrhage
 Diabetes mellitus
 Drug abuse
 Duration of symptoms ……
 Physical Examination
 Weight loss
 Hypotension
 Hypertension
 Tachycardia
 Poor skin turgor
 Bladder distension
 Prostate enlargement …….
VI. Diagnosis

15. VI. Diagnosis
2. Investigations
 Blood test: blood test help find level of:
 Creatinine :
• For male normal range (0.7 - 1.3) mg/dl
• For female normal range (0.6 - 1.1) mg/dl
 BUN(Blood urea nitrogen) : normal range (7 -20 ) mg/dl
 Phosphorus: normal range (2.5 - 4.5) mg/dl
 Potassium: normal range (3.5 - 5.2) mEq/l (mille Equivalents per liter)
 Calcium: normal range (8.5 – 10.5) mg/dl

16. 2. Investigations
 Urine test: Na+ (Sodium), Creatinine, Osmolality.
 Imaging test:
 Renal ultrasound
 CT scan (abdomen pelvis)
Renal biopsy
Urine culture: If infection is suspected.
VI. Diagnosis

17. VII.Differential diagnosis
AKI CKD
Cause
 Ischemia
 Nephrotoxins
 Sepsis
 Radiocontrast
 Hypertension
 Glomerulonephritis
 Diabetes
 Urinary obstruction
 Hereditary
Duration of symptoms <90 days >90 days
Laboratory test
 Increase serum creatinine
occurs rapidly over several
days.
 Increase serum creatinine
over month to year.
Other diagnosis test
 Proteinuria is rare or in low
amounts (< 500mg/24h).
 Proteinuria is common and
high amounts (1g/24h).

18. VIII.Complication
 Uremia
 Hypervolemia and hypovolemia
 Hyponatremia
 Hypernatremia
 Hyperphosphatemia and hypocalcemia
 Bleeding
 Infections
 Cardiac Complication
 Malnutrition

19. IX. Management
 Correct hypovolaemia and optimize systemic haemodynamic status with inotropic
drugs if necessary.
 Administer glucose and insulin to correct hyperkalaemia if K+ > 6.5 mmol/L
 Consider administering sodium bicarbonate (100mmol) to correct acidosis if PH<7
 Discontinue potentially nephrotoxic drugs and reduce doses of therapeutic drugs
according to level of renal function

20.  Match fluid intake to urine output plus an additional 500mL to cover
insensible losses once patient is euvolaemic.
 Measure body weight on a regular basic as a guide to fluid requirements
 Ensure adequate nutritional support.
 Screen for intercurrent infections and treat promptly if present
IX. Management

21. Reference
 Mayoclinic : June 23, 2018
https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-
20369048
 (Step-Up Series) Steven S. Agabegi, Elizabeth D. Agabegi - Step-Up to Medicine-LWW
(2015)
 Researchgate
https://www.researchgate.net/figure/Features-that-allow-the-differential-diagnosis-of-AKI-
and-CKD_tbl2_225055682
 Sruart Ira Fox : Human Physiology
 Dee Unglaub Silverthorn : Human Physiology, An Integrated Approach, Seventh
Edition.
 Bmj-Best Practice, January 2019
https://bestpractice.bmj.com/topics/en-
gb/83?q=Acute%20kidney%20injury&c=suggested