Acute kidney injury: Epidemiology and assessment

Abstract

Acute renal failure, now called acute kidney injury (AKI), is common and costly and carries a very high morbidity and mortality. As it is often preventable, identification of at-risk patients and institution of appropriate preventive measures are crucial; rapid recognition and treatment may prevent irreversible nephron loss, even death. Most cases of AKI are initially managed by non-specialist clinicians, often comparatively junior ones; therefore, all clinicians need to be au fait with the initial assessment and management of AKI. Nephrologists need to ensure that referring teams are supported in recognising the symptoms and signs of AKI, requesting and interpreting initial investigations, initiating appropriate treatment and knowing when to refer on to the renal team. This chapter covers the common causes of AKI, defines at-risk populations, outlines the clinical diagnostic approach and highlights ways of predicting risk of AKI.