Acute Renal FailureMuhammad Hazim bin AzizulAKI DefnitionAKI is defned as any of the following (ot !raded"#Increase in $%r by & '() mg*dl (&+,(- micrmol*l" within ./ hours0 orIncrease in $%r to&1(- times baseline2 which is 3nown or 4resumed to ha5e occurred within the 4rior 6 days0 or7rine 5olume 8'(- ml*3g*h for , hours(Acute kidney injury stagesAKI $9A!:$erum creatinine criteria7rine out4ut criteria1 Increase in serum creatinine of 26 micromol/litre or more within 48 hoursOR1.5 to 2-fold increase from baselineess than !.5 ml/"#/hour for more than 6 hours*2 Increase in serum creatinine to more than 2 to $-fold from baseline ess than !.5 ml/"#/hour for more than 12 hours3 Increase in serum creatinine to more than $-fold from baselineOR%erum creatinine more than $54 micromol/litre with an acute increase of at least 44 micromol/ litreess than !.$ ml/"#/hour for 24 hours or anuria for 12 hours Ris3 factors%hronic 3idney disease (or history of" Diabetes Heart failure $e4sis Hy4o5olaemiaAge ,- years or o5er7se of drugs with ne4hroto;ic 4otential (for e;am4le2 $AIDs2 A%: inhibitors"7se of iodinated contrast agents within 4ast wee3 uate fltration is less e?ecti5e decrease in renal functionclinical e5idence of @ true@ hy4o5olemia (eg2 hemorrhage2 5omiting2 diarrhea2 diuresis2 burns2 hy4er4yre;ia" decreased @ e?ecti5e@ circulatory 5olume (eg2 cardiac or li5er failure2 se4sis"( Defniti5e diagnosis rests on ra4id reco5ery of glomerular fltration rate after the restoration of renal 4erfusion:tiologyIntrinsic Renal Azotemia glomeruli A acute 4oststre4tococcal glomerulone4hritis2 idio4athic ra4idly 4rogressi5e glomerulone4hritis2 and systemic lu4us erythematosus(3idneyBs interstitium A acute allergic interstitial ne4hritis2 infections2 or infltration from diseases such as sarcoidosis and lym4homa( 9ubules A usuallynecrosis secondary to long 4eriods of hy4otension2 ne4hroto;ic drugs (antibiotics such as aminoglycoside and radiological contrast agents":tiologyPostrenal Etiologies uency2 hesitation2 gross hematuria2 4ain in the costo5ertebral angle and groin2 and anuria(Rele5ant history&rine out'ut histor()Oli#uria #enerall( fa*ors +,I. +bru't anuria su##ests acute urinar( obstruction- acute and se*ere #lomerulone'hritis- or embolic renal arter( occlusion. + #raduall( diminishin# urine out'ut ma( indicate a urethral stricture or bladder outlet obstruction due to 'rostate enlar#ement. Rele5ant historyPrerenal failurecommonly 4*w sym4toms related to hypovolemia:thirst, decreased urine output, dizziness2 and orthostatic hypotension( 5olume loss from vomiting, diarrhea, sweating, polyuria2 or hemorrhageIntrinsic renal failuree4hritic syndrome of hematuria, edema, and hypertension indicates a glomerular etiology for AKI( Euery about prior throat or skin infections( Acute tubular necrosis (A9" C 4eriod ofhypotensione;4osure to ne4hroto;ins should include a detailed list of all current medications and any recent radiologic examinationsPostrenal failure4rostatic obstruction and sym4toms of urgency, freuency, and hesitancy in elderly! "lank pain and hematuria should raise a concern about renal calculiFhysical :;aminationHydration status$e4tic loo3ing%linical features of heart failureIn5estigationsG7 :lectrolytesGlood gases C Acidosis7feme 7$ K7GManagementMaintenance of 5olume homeostasis and correction of biochemical abnormalities remain the 4rimary goals of treatment#%orrection of =uid o5erload with frusemide %orrection of se5ere acidosis with bicarbonate %orrection of hy4er3alemia %orrection of hematologic abnormalities (eg2 anemia" such as transfusionsManagement Monitory closely hydration status#Dungs C cre4itations7rine out4ut%54 monitoringFre5ention of contrastCinduced ne4hro4athy #a$%&' isotonic aH%