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Clin Kidney J. 2017 Jun;10(3):323-331. doi: 10.1093/ckj/sfx003. Epub 2017 Mar 15.

Acute kidney injury-an overview of diagnostic methods and clinical management.

Author information

1
Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
2
Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden.
3
Deparment of Medicine, University of Otago Christchurch and Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
4
Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
5
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
6
Department of Emergency Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden.

Abstract

Acute kidney injury (AKI) is a common condition in multiple clinical settings. Patients with AKI are at an increased risk of death, over both the short and long term, and of accelerated renal impairment. As the condition has become more recognized and definitions more unified, there has been a rapid increase in studies examining AKI across many different clinical settings. This review focuses on the classification, diagnostic methods and clinical management that are available, or promising, for patients with AKI. Furthermore, preventive measures with fluids, acetylcysteine, statins and remote ischemic preconditioning, as well as when dialysis should be initiated in AKI patients are discussed. The classification of AKI includes both changes in serum creatinine concentrations and urine output. Currently, no kidney injury biomarkers are included in the classification of AKI, but proposals have been made to include them as independent diagnostic markers. Treatment of AKI is aimed at addressing the underlying causes of AKI, and at limiting damage and preventing progression. The key principles are: to treat the underlying disease, to optimize fluid balance and optimize hemodynamics, to treat electrolyte disturbances, to discontinue or dose-adjust nephrotoxic drugs and to dose-adjust drugs with renal elimination.

KEYWORDS:

acute kidney injury; diagnosis; review; therapeutics

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