PROSPECTIVE STUDY OF ETIOLOGY, CLINICAL PROFILE AND OUTCOME OF ACUTE KIDNEY INJURY IN TERITIARY CARE HOSPITAL, KING GEORGE HOSPITAL, VISAKHAPATNAM, AP, INDIA.

Dr Sruthi Suresh Nair, Dr S. Sreenivas

Abstract


INTRODUCTION
Acute kidney injury is a common clinical syndrome characterized by
an abrupt decline of renal function and has been recognized as a major
health care problem affecting millions of patient's worldwide. Acute
kidney injury (AKI) is a heterogeneous syndrome dened by rapid
(hours to days) decline in the glomerular ltration rate (GFR) resulting
in the retention of metabolic waste products, including urea and
creatinine, and dysregulation of uid, electrolyte, and acid-base
homeostasis. The term acute kidney dysfunction might better
characterize the entire spectrum of the syndrome. However, acute
kidney injury is the term that has been increasingly utilized in the
medical literature. Acute kidney injury can develop de novo in the
setting of intact kidney function or can be superimposed on underlying
chronic kidney disease. In fact, the presence of underlying impaired
kidney function has been shown to be one of the most important risk
factors for the development of AKI. The etiology and outcomes of AKI
are mainly inuenced by the circumstances in which it occurs, such as,
whether it develops in the community or in the hospital. It is important
to distinguish whether the kidney injury occurs as an isolated process
that is more common in community acquired AKI, or it occurs as part
of a more extensive multi organ syndrome. In 2004, Acute Dialysis
Quality Initiative (ADQI) group, International Society of Nephrology
(ISN),National Kidney Foundation(NKF)and American - 2 - Society
of Nephrology (ASN) met and proposed the term Acute Kidney Injury.
AKI generally dened as: an abrupt and sustained decrease in kidney
function' In 2004, Acute Kidney Injury Network (AKIN) was formed.
AKIN proposed a diagnostic criteria for the denition AKI. An abrupt
(within 48 hours) reduction in kidney function currently dened as an
absolute increase in serum creatinine of more than or equal to 0.3 mg/dl
(≥ 26.4 μmol/l), a percentage increase in serum creatinine of more than
or equal to 50% (1.5-fold from baseline), or a reduction in urine output
(documented oliguria of less than 0.5 ml/kg per hour for more than six
hours). Decreased urine output is a cardinal manifestation of AKI, and
patients are often classied based on urine ow rates as non oliguric
(urine output >400 mL/day), oliguric (urine output <400 mL/day), or
anuric (urine output <100 mL/day). Data emerged recently suggesting
small increases in Serum Creatinine may be associated with adverse
outcomes than those considered in RIFLE criteria. So AKIN proposed
a new classication/staging system. oliguric AKI is associated with
higher mortality risk than non oliguric AKI, therapeutic interventions
to augment urine output have not been shown to improve patient
outcomes.


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