Acute Kidney Injury (AKI)

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What is Acute Kidney Injury (AKI)?
AKI is also known as acute renal failure. If you have AKI it means your kidneys have suddenly stopped working properly. It is not the result of the physical blow to the kidney but an internal process. This can happen over a few hours, days, or weeks. The effect can range from minor loss of kidney function to major kidney failure.

AKI affects both your kidneys. AKI is usually seen in older people who are unwell enough to be admitted to hospital. If it is not picked up in time the kidneys can become overwhelmed and shut down, which can become life threatening if not detected early and treated quickly.

What do my kidneys do normally?
Your kidneys do lots of important jobs to keep you healthy:
– Clean your blood
– Get rid of waste products
– Keep the right amount of chemicals and salts in your blood, like sodium and potassium
– Help to keep the right amount of fluid in your body and help make urine
– Help make red blood cells (prevents you getting anaemic)
– Help keep acid levels right in your body
– Help with maintaining healthy bones and blood pressure.

What causes AKI?
AKI is common and normally happens as a complication of another serious illness. AKI may be caused by stress to your kidneys from infection, dehydration, heavy blood loss and some types of medication.

What are the symptoms of AKI?
Some patients have no signs or symptoms at all, and it is only detected on a blood test. Some patients might have symptoms such as:
• Not passing much urine no urine at all
• Passing red or brown urine
• Swelling of feet and legs
• Shortness of breath
• Loss of appetite, feeling sick or vomiting,
• Tiredness, drowsiness, confusion.
• Feeling itchy.

How do we diagnose AKI?
You will need blood tests and urine tests, sometimes regularly, whilst the AKI is monitored. You might need a scan of your kidneys to see if your kidneys are blocked. Sometimes you will need a kidney biopsy to find out what is causing the AKI.

How do we treat AKI?
It depends on the underlying cause. Some patients will need:
– Drip/s if they are dehydrated;
– Antibiotics if there is an infection;
– A bladder catheter if there is a blockage to the bladder or to allow the medical team to monitor how much urine you are making.

In some cases, kidney function gets worse despite treatment and you might need dialysis to clean your blood and help remove waste products, until your kidneys improve. There are a small number of patients whose kidneys will never recover from AKI and if this happens you will remain under the care of kidney specialists, may need permanent dialysis and further treatment options then discussed.

What about medications?
Sometimes medications taken for other reasons can affect the kidneys and cause AKI. These include NSAIDs for example Ibuprofen, Naproxen or Diclofenac; blood pressure tablets for example Lisinopril, Ramipril, Losartan or Candesartan; diuretics (‘water tablets’) for example Furosemide or Spironolactone. Some medicines are processed in the body by the kidneys and therefore can make AKI worse or some might not work as well if your kidneys are not working. In the hospital your prescription will be reviewed by your doctor or pharmacist and they might change or stop some of medicines. There are some medicines you will be advised to stop in the future if you are unwell or become dehydrated. These are called “sick day rules” and your doctor or pharmacist will discuss this with you.

What happens after you go home?
We will tell your GP that you have had AKI. Your GP may want to recheck your blood tests or see you soon after you are discharged. Most patients’ kidneys will get better and make a full kidney recovery. As there is a risk of AKI in future, if you were to become unwell again you should tell all healthcare professionals treating you that you have had AKI in the past. Please check with your Doctor, nurse or pharmacist before taking any new medicines.

We suggest you keep your blood pressure under control and eat a healthy diet in the future.

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