From the Guidelines
Acute kidney injury (AKI) and kidney disease are primarily caused by prerenal, renal, or postrenal factors, with prerenal and renal etiologies accounting for over 97% of AKI cases. The most common causes of AKI include severe dehydration, infections such as sepsis, certain medications like NSAIDs and antibiotics, urinary tract obstructions, and direct kidney damage from conditions like rhabdomyolysis or autoimmune diseases 1. Other significant causes include major surgeries, heart failure, and liver failure, as well as certain toxins like alcohol, recreational drugs, and heavy metals.
Key Causes of AKI and Kidney Disease
- Prerenal factors: impaired blood flow due to hypotension, hypovolemia, decreased cardiac output, or renal artery occlusion
- Renal causes: diseases that damage renal parenchyma, such as vasculitis, acute tubular necrosis, glomerulonephritis, interstitial nephritis, renal infection or infiltration, drugs, and toxins
- Postrenal AKI: ureteral, bladder, or urethral obstruction
- Chronic kidney disease (CKD) is often caused by hypertension and diabetes, and is defined as an abnormality of kidney structure or function present for over 3 months, with health consequences 1.
Importance of Early Recognition and Treatment
Early recognition of symptoms like decreased urination, swelling, fatigue, and confusion is crucial for prompt treatment, which typically focuses on addressing the underlying cause while supporting kidney function until recovery. Identification of the specific cause of AKI is critical, as there are different treatments for diseases such as glomerulonephritis, vasculitis, and ureteral obstruction 1. Evaluation of the patient with AKI or CKD includes a thorough history, physical examination, and laboratory analysis of blood and urine, as well as renal biopsy in some cases 1.
Classification and Staging of Kidney Disease
The classification system for AKI, acute kidney disease (AKD), and CKD is based on the severity of functional abnormalities or structural abnormalities, as well as the cause of disease 1. The Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference proposes a classification system that differentiates AKD without AKI and AKD with AKI, and acknowledges the different entities because management considerations may differ 1. Severity staging for AKI and CKD, irrespective of cause, drives prognostic and management recommendations, with more severe stages portending worse outcomes 1.
From the FDA Drug Label
Dopamine Hydrochloride in 5% Dextrose Injection, USP is indicated for the correction of hemodynamic imbalances present in shock due to myocardial infarction, trauma, endotoxic septicemia, open heart surgery, renal failure and chronic cardiac decompensation as in refractory congestive failure The causes of acute kidney injury (AKI) and kidney disease mentioned in the label are:
- Renal failure
- Trauma
- Endotoxic septicemia
- Myocardial infarction
- Open heart surgery
- Chronic cardiac decompensation as in refractory congestive failure 2
From the Research
Causes of Acute Kidney Injury (AKI) and Kidney Disease
- AKI is a complex and life-threatening condition with multifactorial etiologies, ranging from ischemic injury to nephrotoxic exposures 3
- Systemic illness or toxic exposure are common causes of AKI, and determining the cause is critical when possible 4
- AKI can be caused by various factors, including:
- Ischemic injury
- Nephrotoxic exposures
- Systemic illness
- Toxic exposure
- Nephrotoxic drugs
- Ischemic renal disease (IRD) is a common and often overlooked clinical entity that presents itself in the setting of extrarenal arteriosclerotic vascular disease in older individuals with azotemia, and can lead to chronic renal failure and end-stage renal disease 5
- Atherosclerotic renal artery disease is a progressive disorder, and its progression is associated with loss of renal mass and functioning, and can lead to IRD 5
Risk Factors for AKI and Kidney Disease
- Risk factors for AKI include:
- Nephrotoxic drugs
- Systemic illness
- Toxic exposure
- Atherosclerotic renal artery disease
- Extrarenal arteriosclerotic vascular disease
- Hypertension
- Patients with coronary artery disease, aortic and peripheral vascular disease are at higher risk of developing atherosclerotic renal artery disease and IRD 5
Diagnosis and Treatment of AKI and Kidney Disease
- Early diagnosis and treatment of AKI can increase survival rates, and the use of biomarkers can enable clinicians to perform an early diagnosis and indicate treatment before the stages of AKI progression are established 6
- Treatment of AKI includes control of the underlying cause, achievement and maintenance of euvolemia, nutritional optimization, blood glucose control, and pharmacotherapy 4
- Renal replacement therapy is the only current alternative available for renal patients with AKI, and treatment methods for IRD include percutaneous transluminal angioplasty, endovascular stenting, and surgical revascularization 7, 5