ACUTE KIDNEY INJURY (AKI)-PROGNOSIS

SUMMARY

1. Pre-renal: resolves (improvement in renal function) quickly 24-48 hours with treatment/correction of the underlying insult.

2. ATN: does not resolve despite treatment/correction of the underlying insult. Will recover but days to weeks for renal tubules to re-generate.

3. Note that some component of injury may be pre-renal and others ATN-related.

Grampian Laboratory Outcomes Morbidity and Mortality Study II (GLOMMS II)
4. Greater % of individuals experiencing AKI had a 30% decline in renal function & developed CKD stage 4 during 9 years of follow-up.

5. Those individuals with greater renal function and AKI were most at risk of a reduction in renal function compared to those with pre-existing CKD.

6. Those that experienced AKI were older, with greater co-morbidities, more likely to be admitted in an emergency situation (cf elective admission) and to a critical care setting.

Reference(s)

Sawhney S, Marks A, Fluck N, Levin A, McLernon D, Prescott G, Black C. Post-discharge kidney function is associated with subsequent ten-year renal progression risk among survivors of acute kidney injury. Kidney Int. 2017 Aug;92(2):440-452. doi: 10.1016/j.kint.2017.02.019. Epub 2017 Apr 14. PMID: 28416224; PMCID: PMC5524434.
Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].