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From the Research
Acute kidney injury (AKI) is classified into three main types: pre-renal, intrinsic, and post-renal, and understanding the specific type is crucial for appropriate management and preventing further kidney damage. AKI is a clinical syndrome characterized by a rapid decline in glomerular filtration rate and resultant accumulation of metabolic waste products 1. The three main types of AKI are:
- Pre-renal AKI, which occurs due to decreased blood flow to the kidneys, often from dehydration, heart failure, or severe blood loss
- Intrinsic AKI, which involves direct damage to the kidney tissue itself, commonly from nephrotoxic medications (like NSAIDs, aminoglycosides, or contrast dye), sepsis, or prolonged ischemia
- Post-renal AKI, which results from obstruction to urine outflow, such as from kidney stones, enlarged prostate, or tumors Diagnosis typically involves blood tests (BUN, creatinine), urine output monitoring, and imaging studies 2. Treatment depends on the underlying cause but generally includes addressing the primary issue, maintaining fluid balance, avoiding nephrotoxic agents, and sometimes dialysis for severe cases 3. It is essential to determine the 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 2.
The management of AKI should focus on treatment of the underlying cause, prevention of further injury, management of complications, and short-term renal replacement therapy in case of refractory complications 1. Long-term follow-up of individuals recovered from AKI is recommended, but the most effective models of care remain unclear 1. Early determination of etiology, management, and long-term follow-up of AKI are essential to reduce the risk of cardiovascular disease, chronic kidney disease, and death 4.