Question

What actions and treatment can reverse AKI at the initiation phase?

Answer 1

Acute kidney injury (AKI) is the leading cause of nephrology consultation and is associated with high mortality rates. The primary causes of AKI include ischemia, hypoxia or nephrotoxicity. An underlying feature is a rapid decline in GFR usually associated with decreases in renal blood flow. Inflammation represents an important additional component of AKI leading to the extension phase of injury, which may be associated with insensitivity to vasodilator therapy. It is suggested that targeting the extension phase represents an area potential of treatment with the greatest possible impact. The underlying basis of renal injury appears to be impaired energetics of the highly metabolically active nephron segments (i.e., proximal tubules and thick ascending limb) in the renal outer medulla, which can trigger conversion from transient hypoxia to intrinsic renal failure. Injury to kidney cells can be lethal or sublethal. Sublethal injury represents an important component in AKI, as it may profoundly influence GFR and renal blood flow. The nature of the recovery response is mediated by the degree to which sublethal cells can restore normal function and promote regeneration. The successful recovery from AKI depends on the degree to which these repair processes ensue and these may be compromised in elderly or CKD patients. Recent data suggest that AKI represents a potential link to CKD in surviving patients. Finally, earlier diagnosis of AKI represents an important area in treating patients with AKI that has spawned increased awareness of the potential that biomarkers of AKI may play in the future.

Action:

Unlike kidney failure that results from kidney damage that gets worse slowly, AKI is often reversible if it is found and treated quickly. If you were healthy before your kidneys suddenly failed and you were treated for AKI right away, your kidneys may work normally or almost normally after your AKI is treated.

Because AKI happens suddenly, it can be hard to predict or prevent it. But taking good care of your kidneys can help prevent AKI, chronic kidney disease (CKD) and kidney failure/ESRD. Follow these general rules to keep your kidneys as healthy as possible:

• Work with your doctor to manage diabetes and high blood pressure.
• Live healthy! Eat a diet low in salt and fat, exercise for 30 minutes at least five days per week, limit alcohol and take all prescription medicines as your doctor tells you to.
• If you take over-the-counter pain medicines, such as aspirin or ibuprofen, do not take more than is recommended on the package. Taking too much of these medicines can hurt your kidneys and can cause AKI.

Treatment:

The treatment for AKI depends on what caused it to happen. Most people need to stay in the hospital during treatment and until their kidneys recover. While you are being treated for the problem that caused your AKI, you may also have treatments to prevent problems that can make it harder for your kidneys to heal. Some possible treatments include:

• Temporary hemodialysis to do the work that your kidneys should be doing, until they can recover
• Medicines to control the amounts of vitamins and minerals in your blood
• Treatments to keep the right amount of fluid in your blood

When you return home, your doctor may ask you to follow a kidney-friendly diet plan to help your kidneys continue to heal. Your doctor may be able to refer you to a dietitian, who can help you make a kidney-friendly diet plan that works for you.