Pathologic kidney specimen showing marked pallor of the cortex, contrasting to the darker areas of surviving medullary tissue. The oxford handbook of acute medicine pdf free died with acute kidney injury.
The clinical picture is often dominated by the underlying cause. The symptoms of acute kidney injury result from the various disturbances of kidney function that are associated with the disease. AKI often occurs due to multiple processes. Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function. Intrinsic AKI refers to disease processes which directly damage the kidney itself. The deterioration of kidney function may be signaled by a measurable decrease in urine output.
Both tests have their disadvantages. For instance, it takes about 24 hours for the creatinine level to rise, even if both kidneys have ceased to function. Once the diagnosis of AKI is made, further testing is often required to determine the underlying cause. It is useful to perform a bladder scan or a post void residual to rule out urinary retention. In post void residual, a catheter is inserted into the urinary tract immediately after urinating to measure fluid still in the bladder.
US fails to demonstrate abnormalities. In evaluation of the acute changes in the kidney, the echogenicity of the renal structures, the delineation of the kidney, the renal vascularity, kidney size and focal abnormalities are observed. CT is preferred in renal traumas, but US is used for follow-up, especially in the patients suspected for the formation of urinomas. A CT scan of the abdomen will also demonstrate bladder distension or hydronephrosis. Renal ultrasonograph in renal failure after surgery with increased cortical echogenicity and kidney size.
Biopsy showed acute tubular necrosis. The management of AKI hinges on identification and treatment of the underlying cause. Monitoring of kidney function, by serial serum creatinine measurements and monitoring of urine output, is routinely performed. The myriad causes of intrinsic AKI require specific therapies. Study results regarding differences in outcomes between IRRT and CRRT are inconsistent. Among critically ill patients, intensive renal replacement therapy with CVVH does not appear to improve outcomes compared to less intensive intermittent hemodialysis.