From the Guidelines
AKI EGFR refers to Acute Kidney Injury as measured by estimated Glomerular Filtration Rate, and managing it involves identifying and treating the underlying cause, with a focus on stopping nephrotoxic medications, ensuring adequate hydration, and monitoring fluid balance, as outlined in the most recent guidelines 1.
Key Considerations
- Normal eGFR is typically above 90 mL/min/1.73m², while values below 60 indicate kidney damage.
- AKI is diagnosed by a 50% or greater sustained increase in serum creatinine over a short period of time, which is also reflected as a rapid decrease in eGFR 1.
- People with diabetes are at higher risk of AKI than those without diabetes, and other risk factors include preexisting CKD, the use of medications that cause kidney injury, and the use of medications that alter renal blood flow and intrarenal hemodynamics 1.
Management Approach
- Immediate interventions include stopping nephrotoxic medications (NSAIDs, certain antibiotics), ensuring adequate hydration, and monitoring fluid balance.
- In severe cases with significantly reduced eGFR, temporary dialysis may be necessary.
- Regular monitoring of creatinine levels and urine output helps track kidney recovery.
- The kidneys often have remarkable recovery capacity if the underlying cause is addressed promptly, though some patients may develop chronic kidney disease following AKI.
Important Guidelines
- Elevations in serum creatinine (up to 30% from baseline) with renin-angiotensin system (RAS) blockers (such as ACE inhibitors and ARBs) must not be confused with AKI 1.
- ACE inhibitors and ARBs should not be discontinued for increases in serum creatinine (<30%) in the absence of volume depletion 1.
Outcome Improvement
- Early detection through eGFR monitoring is crucial for improving outcomes in acute kidney injury.
- Timely identification and treatment of AKI is important because AKI is associated with increased risks of progressive CKD and other poor health outcomes 1.
From the Research
Definition and Diagnosis of Acute Kidney Injury (AKI)
- Acute kidney injury (AKI) is defined as an increase in serum creatinine or a decrease in urine output over hours to days 2.
- The severity of AKI is classified according to urine output and elevations in creatinine level 3.
- AKI is associated with an increased risk of mortality, cardiovascular events, and progression to chronic kidney disease 3.
Etiologies and Management of AKI
- Etiologies of AKI are categorized as prerenal, intrinsic renal, and postrenal 2, 3, 4.
- Accurate diagnosis of the underlying cause is key to successful management and includes a focused history and physical examination, serum and urine electrolyte measurements, and renal ultrasonography when risk factors for a postrenal cause are present 3.
- General management principles for AKI include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function 3.
Role of Furosemide in AKI
- Furosemide, a potent loop diuretic, is frequently used in different stages of AKI, but its clinical roles remain uncertain 5.
- The severity of AKI has a significant effect on the diuretic response to furosemide; a good 'urinary response' may be considered as a 'proxy' for having some residual renal function 5.
- The current evidence does not suggest that furosemide can reduce mortality in patients with AKI, but it may be useful in achieving fluid balance to facilitate mechanical ventilation according to the lung-protective ventilation strategy 5.
eGFR and AKI
- There is no direct mention of eGFR in the provided studies, but it is known that eGFR (estimated Glomerular Filtration Rate) is a measure of kidney function and can be used to diagnose and monitor kidney disease, including AKI.