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Understanding acute kidney injury

Understanding acute kidney injury

Kidneys recover almost 100 per cent in acute kidney injury if treated at the earliest

Acute Kidney Injury: why do kidneys fail?

It was a roller coaster ride for a 30-year-old pregnant woman from Bengaluru who had to undergo a caesarean section on her 31st week of pregnancy after her kidneys suddenly failed to filter the waste. Shweta (name changed) found out about her condition of having acute kidney injury during her regular visits to the gynaecologist who informed her that she needed to undergo dialysis. But before that, they decided to perform the pre-term delivery. Her only question was why did her kidneys suddenly fail.

Speaking about her condition, Dr Vidya V Bhat, medical director, Radhakrishna Multispeciality hospital and IVF Center, Bengaluru, says that Shweta did not have any other comorbid conditions or health issues while she was pregnant. “Earlier she had three miscarriages. We treated her for infertility and during her third month of pregnancy, she had pregnancy-induced hypertension when we put her on a medication used to prevent blood clots. She continued well till 28 weeks and on the 29th week, her BP shot up when we put her on anti-hypertensive drugs,” says Dr Bhat.


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Dr Bhat says that her renal function test showed a spike in her creatinine level and anything less than one mg/dL is considered normal. “She went into acute nephritis (a condition where kidneys suddenly become inflamed) and kidney failure. On the 31st week, we had to immediately opt for a C-section and kept the baby in the NICU (neonatal intensive care unit). She underwent three to four dialysis after which she slowly started to recover,” she says.

Differentiating between chronic kidney disease and acute kidney injury (AKI), Dr Atul Ingale, consultant nephrologist and transplant physician, director, department of nephrology, Fortis Hiranandani Hospital, Mumbai, says, “acute kidney injury occurs in a few hours to a few days whereas chronic failure takes at least three months. In AKI, the kidney usually recovers almost 100 per cent but in chronic kidney failure, recovery is a challenge,” he says.

How do our kidneys function?

Dr Ingale says, “kidneys not only filter blood and remove waste but are also responsible for the water balance in our body. During summer, we pass less urine and during winter we pass more. It is the same as when we drink more water, we pass more urine and when we take less water, we pass less urine; the body’s water balance is maintained as the kidneys control it.”

He says that the kidneys are also responsible for acid-base balance, hormone and vitamin production. “Kidneys secrete renin, a hormone responsible for regulating blood pressure thus keeping BP under control. Kidneys also produce a hormone called erythropoietin which is responsible for blood production. Kidneys activate vitamin D and maintain the balance of electrolytes in the body,” he says.

Why do kidneys fail?

Acute kidney injury is also called acute kidney/renal failure. The most common causes are diabetes and high blood pressure, says Dr A Santosh Kumar, senior nephrologist, Kamineni Hospitals, Hyderabad.

Dr Kumar says that this takes place when the kidneys lose function suddenly (within hours or days) and once the kidneys are damaged, they cannot filter the blood properly, causing waste to build up in the body. “Acute kidney injury almost always occurs in connection with another medical condition or an event such as being hospitalised, especially for a serious condition that requires intensive care, advanced age, blockages in the blood vessels in your arms or legs (peripheral artery disease), diabetes, high blood pressure, heart failure, kidney diseases, liver diseases and certain cancers and their treatments,” he says.

Dr Ingale says that multiple reasons could cause acute kidney injury. “If a person is dehydrated due to loose motion, vomiting or even blood loss, their kidneys can fail suddenly. Sometimes fever or infections too can cause malfunction of the kidneys. The abuse of drugs, chemicals and medicine could also result in kidney malfunction. The most common examples could be painkillers and antibiotics. Sometimes even the contrast agents used in the CT scanner or angiography could lead to a failure,” he says.

Who is more vulnerable?

Dr Ingale adds that children and older adults are vulnerable to this condition. “Kids are vulnerable as their body is still developing and sometimes they can’t take the shock due to which their kidneys could fail suddenly. When your body is aged, it will no longer be able to take any shock and they (people above 65) become more vulnerable,” he says. The others who could be affected are the one who has had trauma, accidents or burns. Pregnant women and people with chronic illness are also vulnerable to developing the condition, he says.

Talking about Swetha’s case, Dr Bhat says that she had no other health conditions or issues and her condition was because of pregnancy. She also adds that it is rare to see AKI among pregnant women and in most cases, they have normal health issues such as urinary tract infections and other minor infections; only in a few cases is there renal involvement.

Symptoms to be aware of

Dr Kumar says that chronic kidney disease and kidney failure can cause different symptoms for different people. Some of the symptoms are:

  • Fatigue (extreme tiredness)
  • An upset stomach or vomiting
  • Confusion or trouble concentrating
  • Swelling, especially around the hands or ankles
  • More frequent bathroom trips
  • Muscle spasms (muscle cramps)
  • Dry or itchy skin
  • Poor appetite or metallic taste in food
  • Polycystic kidney disease, a hereditary condition where cysts (fluid-filled sacs) grow inside the kidneys
  • Glomerular diseases, such as glomerulonephritis (inflammation of the tiny filters in the kidneys (glomeruli)
  • Lupus (an autoimmune disease that affects multiple organs) and other autoimmune diseases
  • Blood in the urine/foamy urine
  • Persistent puffiness around the eyes

Dr Ingale says that the cases are always diagnosed by evaluating the urine output per hour and the rise of creatinine levels from the baseline. “Nowadays people are conscious about their health and they visit their physician as soon as they realise that their urine is reducing and the same goes with swelling as well; people rush to doctors to check why they have swelling,” he says.

What are the complications of AKI?

Dr Kumar says that complications of AKI include:

  • Fluid build-up – AKI may lead to a build-up of fluid in the lungs, which can cause shortness of breath
  • Chest pain – If the lining that covers the heart (pericardium) becomes inflamed, you may experience chest pain
  • Muscle weakness – When the body’s fluids and electrolytes — the body’s blood chemistry — are out of balance, it can lead to muscle weakness
  • Permanent kidney damage – Occasionally, acute kidney failure causes permanent loss of kidney function or end-stage renal disease. People with the end-stage renal disease require either permanent dialysis — a mechanical filtration process used to remove toxins and wastes from the body — or a kidney transplant

Preventive measures

Dr Kumar advises people to pay attention to labels when taking over-the-counter (OTC) pain medications. “Follow the instructions for OTC pain medications advised by your physician as taking too much of these medications may increase the risk of kidney injury. Work with your doctor to manage kidney and other chronic conditions. If you have kidney disease or another condition that increases the risk of acute kidney failures, such as diabetes or high blood pressure, stay on track with treatment goals and follow your doctor’s recommendations to manage your condition,” he says.

Make a healthy lifestyle a priority. Be active; eat a sensible, balanced diet; and drink alcohol only in moderation — if at all, he adds.

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