Acute kidney injury: an expert's guide

Acute kidney injury is a condition which can become quite serious if left untreated. In his latest article, highly-esteemed nephrologist Dr Bernhard Klebe explains this condition in detail.

What are the main symptoms of acute kidney injury?

There are quite a few symptoms that a patient may have when they have acute kidney injury. A lot of the time they won't have any symptoms at all, and this is particularly common in the early stages of their illness. But if you've got a kidney injury or kidney failure, you may suffer from symptoms like fatigue or nausea.

A lot of my patients also develop swelling in their ankles and in their feet, and some may even notice a reduction in the amount of urine they produce. Generally, patients feel quite weak, and there are a lot of other symptoms that they can present with. It depends on the underlying problem that's causing the kidney condition.

What is the most common cause of acute kidney injury?

There are various causes of acute kidney injury. It’s important to note that certain types of patients are more at risk of suffering from this condition, including:

• Elderly people
• people who suffer from heart failure or circulation problems
• people with diabetes

More specifically, patients with acute kidney injury can have conditions where their blood pressure is very low, or they are very dehydrated. This can predispose them to kidney damage.

It can also be caused by certain medications such as antibiotics or pain medications. Some may have also received a contrast administered while they are ill in the hospital for certain investigations, those patients can also get acute kidney injury. And lastly, a lot of male patients that I see also present with prostate problems.

If the prostate causes a delay in the drainage of their bladder, men can suffer from urine retention, which can also lead to acute kidney injury. There are numerous causes, and the patients vary across the spectrum of the disease.

How is acute kidney injury diagnosed?

So, kidney failure can be diagnosed in various ways. Your doctor may be suspicious that you have kidney failure based on your symptoms, but generally, it's diagnosed by measuring your urine, or doing a blood test called a creatinine or glomerular filtration rate and comparing that to your most recent results.

There are other more specific tests that we can do depending on how you've presented with your acute problem. And some tests may include a urine dipstick where we look for blood and protein in the urine, and there are various other panels of blood tests that we can choose from.

What are the main stages of acute kidney injury?

There are various stages of acute kidney injury. Over the years, the stages and the classification of acute kidney injury have changed. The most recent classification divides acute kidney injury into three stages, and these are based on the level of change in your blood test for creatinine, or GFR, and they also take into consideration the amount of urine that you are making or, or failing to produce during your illness.

Is acute kidney injury serious?

Acute kidney injury can become very serious if it's left untreated. Patients with acute kidney injury can have significant health problems and they may require quite intensive treatment. However, in a lot of patients, their condition is reversible. Patients who are in general good health can recover quickly if they are treated early and their problem is identified very early on in the disease course.

How should acute kidney injury be treated?

Acute kidney injury can be treated in various ways. One of the most important factors is assessing a patient's hydration status and treating that, as most patients are usually dehydrated and have very low blood pressure.

Removing certain medications that the patient is taking can also be of use. Treating electrolyte problems and acid-based problems is also important. A small proportion of patients do need to be treated with acute haemodialysis. This is where the patient is placed on a life or kidney support system where the blood is cleaned and the waste products are cleared.

Dr Bernhard Klebe is a leading consultant nephrologist based in Canterbury and Ashford. If you would like to book a consultation with Dr Klebeis, you can do so today via his Top Doctors profile.