From the Guidelines
The patient's acute kidney injury has likely been managed appropriately with IV fluid administration, and ongoing management should focus on preventing further kidney injury and addressing the underlying anemia. To prevent further kidney injury, it is essential to maintain adequate hydration and avoid nephrotoxic medications, as supported by the American College of Radiology's guidelines on renal failure 1. The patient should be advised to drink at least 2 liters of fluid daily and temporarily avoid medications such as NSAIDs and certain antibiotics that can exacerbate kidney damage. Follow-up creatinine testing in 1-2 weeks is crucial to ensure continued improvement in kidney function. Regarding the anemia, since iron and B12 levels are normal, further evaluation for other causes is warranted, including:
- Checking folate levels
- Reticulocyte count
- Peripheral blood smear
- Erythropoietin levels, which may be relevant if chronic kidney disease is suspected, as kidneys produce erythropoietin, which stimulates red blood cell production 1. If the anemia persists despite kidney function recovery, additional workup, including hemolysis studies or possibly bone marrow evaluation, might be necessary. The patient should be monitored for symptoms of anemia, such as fatigue, dizziness, or shortness of breath, and managed accordingly to improve quality of life and prevent further morbidity. Key aspects of the patient's management include:
- Preventing further kidney injury through hydration and avoidance of nephrotoxic medications
- Evaluating and managing the underlying anemia
- Monitoring for symptoms of anemia and kidney injury
- Follow-up testing to ensure continued improvement in kidney function.
From the Research
Patient Profile
- 60-year-old female patient with acute kidney injury (AKI)
- Creatinine levels improved after administration of IV fluids in the hospital
- Patient also presented with anemia, but iron and B12 levels were normal
Acute Kidney Injury (AKI)
- AKI is defined as an increase in serum creatinine or a decrease in urine output over hours to days 2
- The condition can be categorized into prerenal, intrinsic renal, or postrenal causes 2, 3
- AKI is associated with an increased risk of cardiovascular disease, chronic kidney disease, and death 2, 4
Anemia and AKI
- Anemia is a common complication in patients with AKI 5, 6
- Studies suggest that anemia can increase the risk of AKI and long-term mortality in critically ill patients 6
- However, in this patient's case, iron and B12 levels were normal, which may indicate that the anemia is not related to iron or B12 deficiency
Management and Treatment
- Initial evaluation and management of AKI include laboratory work-up, medication adjustment, and identification and reversal of underlying cause 2, 3
- Fluid resuscitation with isotonic crystalloid is a common treatment approach for AKI 3
- In this patient's case, IV fluids were administered, which led to an improvement in creatinine levels