Acute kidney injury management


Kidneys are the small bean shaped organs situated in the pelvic region of a human body. These organs play a major role in purifying blood and producing urine. Kidneys are the organs that are majorly known to maintain the acid base balance of the body. However, kidneys can get injured in various ways and thus cause symptoms which are eventually mentioned below. Acute kidney injury is the injury where trauma caused to the kidney is recent and also where the onset of pain is sudden and which can be traced back to its cause or etiology along with abruptly reduced glomerular filtration rate( GFR).

Causes of acute kidney injury.

  • External causes such as penetrating trauma include gunshot injury, stab injuries, road traffic accidents.
  • External causes with blunt trauma such as punching, fall from a height.
  • Insidious causes like high level potassium diet, improper water intake, cancer, hypertension, diabetes, urine retention, old age, kidney stones, etc.
  • Dietary causes such as excessive alcohol consumption, tobacco chewing, excessive use of corticosteroids and analgesics or pain killers.
  • Chronic kidney failure.
  • Necrosis of the kidney.

Symptoms and signs of acute kidney damage.

  • Sharp and shooting pain in the lower abdomen.
  • Tenderness in the lower abdomen.
  • Fever.
  • Rash.
  • History of trauma wound.
  • Haematuria or blood in the urine.
  • Swelling of the foot and legs. Also called as edema.
  • Fainting.
  • Proteinuria or the presence of albumin in the urine.
  • Creatinine in the urine.

Immediate management of acute kidney injury.

Hospitalization is the first and foremost thing to do. It is an emergency situation to deal with. Proper saline and medication administration assure better results.

  • In excessive pain, pain relieving medications are injected.
  • Proper hydration is assured.
  • The patient is monitored with respect to pulse rate, blood pressure, heart rhythm, urine output, oxygen saturation levels.
  • Urinary catheterization is done. ( Foley’s catheter is an example).
  • Acid base balance is monitored to check for acidity and basicity of the blood and to provide artificial buffering actions.
  • Bringing back the uncontrolled blood pressure to normal.
  • Controlling hyperglycemia.
  • Take a quick short history of the patient.
  • The patient is hospitalized for further treatment.
  • The patient may have breathlessness in which mechanical ventilation may be necessary. In some cases, intubation is required.
  • The dialysis machine is connected to the patient to purify the blood and filter urea and ammonium from the blood.

Early management of acute kidney injury.

The patient is stable by now and doctors seek to find the cause of the issue.

  • Urinalysis is done to check the levels of albumin and creatinine in the urine.
  • Renal function tests are carried out.
  • In some cases, a renal biopsy can be necessary.
  • Histological studies are done.
  • Blood tests to check White blood cell and red blood cell counts along with hemoglobin levels.
  • Elevated WBC count in blood denotes infection.
  • Ultrasound is done to check the kidney’s appearance and position.
  • Relaxation therapy.
  • Mechanical ventilation if required.
  • Haemodialysis is in the severe stage of the injury.
  • Detailed history and assessment are done.
  • Family history, habits, and lifestyle information should be collected.
  • Family education and patient education should be given.
  • Treatment according to the cause of the acute renal injury should be decided.

Management of the patient with acute kidney injury.

Management of acute kidney injury by diet.

Diet can help the kidney stay healthy and carry out its functions well. So after the immediate treatment, one has to maintain a regime for their kidneys. So dietary modifications for acute kidney injuries include:

  • Low potassium diet.
  • Low phosphorus diet.
  • Sodium should be minimized to control hypertension.
  • Stop the use of dry fruits such as raisins, cashews, nuts, figs, etc.
  • Avoid the use of potatoes, tomatoes, green leafy vegetables.
  • Avoid canned foods and foods like cheese, butter with high cholesterol levels.
  • Use more of brown rice, dal, fruit juices.
  • Eat less with more number of times that is less food and more frequency.
  • Control and count the number of calories to consume.
  • Avoid fleshly forms of protein in the diet.
  • Water consumption should be as per your doctor’s opinion.

Management of acute kidney disease with lifestyle modification.

Most of the acute renal damage patients give a history of heavy alcohol consumption. So, heavy alcohol intake is a secondary but most important exacerbating factor for kidney damage. 

  • Avoid alcohol.

Uncontrolled hypertension is a problem that leads to renal failure. Controlling controlling blood pressure is important.

  • Yoga, meditation to control BP.
  • Reduced sodium intake.
  • Regular medication.
  • Stress reduction.

Diabetes is another leading cause paving way for acute renal damage.

  • Stop the usage of sugar in food preparations.
  • No use of preservatives of artificial origin.
  • Avoid animal proteins that are non-vegetarian diets.

Other management methods:

  • Psychological counseling for patient and family.
  • Stress reduction.
  • Avoid their occurrence of this condition by proper management.
  • Regular exercise in the form of walking, jogging, swimming.
  • Proper sleep and time to time food intake are a must.

What are the consequences of inappropriate management of acute renal injury?

  1. Chronic renal failure which occurs as a result of recurrent acute attacks of renal damage.
  2. Total kidney failure.
  3. Adrenal gland necrosis.
  4. Acid base imbalance.
  5. A haphazard rise in blood pressure.
  6. Swelling in the arms and legs.
  7. Lightheadedness.
  8. Heart failure.
  9. Central nervous system dysfunction.
  10. Permanent dialysis.
  11. Altered blood smears.
  12. It can lead to multi-organ failure.
  13. Death.