NAVIGATING CHALLENGES IN ACUTE KIDNEY INJURY DIAGNOSIS AND MANAGEMENT: RECENT INSIGHTS
Main Article Content
Keywords
Nephrological skills, Extracorporeal therapy, Creatinine, Glomerular filtration rate (GFR), Diagnostic criteria, Renal excretory capacity, Tubular damage, Parenchymal damage, Renal plasma flow, Biomarkers, Fractional excretion of sodium (FeNa).
Abstract
Introduction: Acute kidney injury (AKI) management in intensive care units (ICUs) is globally crucial, including in Pakistan. Recent developments in AKI diagnosis and management are reviewed, focusing on AKI recognition and extracorporeal therapy.
Diagnostic Criteria and Challenges: Standard diagnostic criteria based on creatinine and urinary volume variations have improved AKI definition and classification. Challenges persist in differentiating AKI causes and accurately assessing prognosis.
Limitations of Creatinine-based Diagnosis: Creatinine-based diagnosis lacks indicators for parenchymal renal damage, aetiology, prognosis, or treatment response. Scenarios of creatinine increase without structural renal damage highlight the need for a nuanced approach.
Alternative Markers for Early Detection: Exploration of alternative markers includes reduced glomerular filtration, tubular damage, upregulated proteins, and molecules responsive to pathological triggers.
Diagnostic Pathway: The diagnostic pathway for AKI involves various tests like pharmacological history, renal ultrasound, intra-abdominal pressure measurement, and urinary sediment analysis.AKI in the Context of Infection: Discussion on AKI aetiology complexity in critically ill patients, focusing on AKI in bacterial endocarditis, glomerulonephritis, and drug-induced interstitial nephritis.
Conclusion: Advancements in AKI diagnosis and biomarker research are acknowledged, while challenges remain in their integration into clinical practice.Emphasis on nephrologist involvement for a holistic approach considering functional and pathological aspects of renal damage in critically ill patients
References
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16. Ng, P. Y., et al. (2024). "Risk of acute kidney injury in critically ill patients with COVID-19 compared with seasonal influenza: a retrospective cohort study." Clinical medicine 70.
17. Rout, N. K., et al. (2024). "Impact of a Short Educational Session on Early Diagnosis and Management of Acute Kidney Injury for Different Specialties." Cureus 16(4).
18. Salmito, F. T. S., et al. (2024). "Endothelium-related biomarkers enhanced prediction of kidney support therapy in critically ill patients with non-oliguric acute kidney injury," Scientific Reports 14(1): 4280.
19. Wang, D.-H., et al. (2024). "Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study." BMC nephrology 25(1): 125.
20. Wang, J., et al. (2024). "Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis." Renal Failure 46(1): 2298900.
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Reem Maged Mahmoud Younes Elsherbiny
Visitor Resident Doctor, Department of Pediatric, Cairo University, Egypt
Muhammad Hamza Farooq
Final Year MBBS Student, International School of Medicine, International University of Kyrgyzstan, Pakistan
FNU Vishal
General Physician, Department of Medicine, Chandka Medical College, Pakistan
Likowsky Desir
MPH, MSc, Department of Surgery, Wyckoff Heights Medical Center, United States
Nusiba Ahmed
Doctor, Department of Internal Medicine, Al-Zaiem Al-Azhari University, Sudan, United States
Dr. Eaman Hamid
General Practitioner, Department of Medicine, Omdurman Islamic University, Sudan, United States