Acute Kidney Injury (AKI) Treatment

What is acute kidney injury?

AKI is a sudden decline in kidney function — measured by a rise in serum creatinine, a drop in urine output, or both — over hours to days. Causes are categorized as pre-renal (volume depletion, cardiorenal syndrome), intrinsic (acute tubular necrosis, glomerulonephritis, interstitial nephritis), or post-renal (obstruction). Each category requires a different diagnostic and therapeutic pathway.

Common causes seen at the bedside

• Sepsis and septic shock with hemodynamic AKI
• Contrast-induced nephropathy after cardiac catheterization or imaging
• Drug-induced AKI: vancomycin, aminoglycosides, NSAIDs, PPI-associated interstitial nephritis
• Post-cardiac-surgery AKI
• Acute glomerulonephritis and rapidly progressive presentations
• Cardiorenal syndrome in decompensated heart failure

Inpatient nephrology consultation

Early nephrology involvement reduces duration of AKI and improves recovery. Bedside evaluation includes urine sediment review, fractional excretion calculations, ultrasound interpretation, and protocolized escalation to CRRT or intermittent hemodialysis when indicated. Dr. Kottarathara's published case work — including 5-oxoproline-related metabolic acidosis (NKF 2017) — informs a careful diagnostic workup beyond first-line attribution.