Porth's Essentials of Pathophysiology, 4e

enal failure is a condition in which the kidneys fail to remove metabolic end products from the blood and regulate the fluid, electrolyte, and pH balance of the extracellular fluids. The underlying cause may be renal disease, systemic disease, or urologic defects of nonrenal origin. Renal failure can occur as an acute or a chronic disorder. Acute kidney injury is abrupt in onset and often is reversible if recognized early and treated appro- priately. In contrast, chronic kidney disease is the end result of irreparable damage to the kidneys. It develops slowly, usually over the course of a number of years and often requires dialysis therapy or transplantation. Acute Kidney Injury Acute kidney injury (AKI), formerly known as acute renal failure, represents an abrupt decline in kidney func- tion, resulting in an inability to maintain fluid and elec- trolyte balance and excrete nitrogenous wastes. 1–7 Acute kidney injury is a common threat to seriously ill persons, in whom it is associated with a high rate of adverse out- comes, with mortality rates ranging between 25% and 80% depending on the cause and clinical status of the patient. 1 This high mortality rate probably reflects the facts that AKI is often seen in elderly persons and that it is frequently superimposed on other life-threatening conditions, such as trauma, shock, and sepsis. Acute renal injury is commonly defined as an abrupt (within 48 hours) reduction in kidney function based on an increase in serum creatinine level, a reduction in urine output, and the need for dialysis, or a combination of these factors. The range of clinical manifestations can vary from mild to severe, based on the degree of rise in creatinine levels and decrease in urine output. Types of Acute Kidney Injury Acute kidney injury can be caused by several types of conditions, including a decrease in blood flow without Acute Kidney Injury and Chronic Kidney Disease 26 C h a p t e r R

Acute Kidney Injury

Types of Acute Kidney Injury Prerenal Injury Postrenal Injury Intrarenal Injury Diagnosis and Treatment

Chronic Kidney Disease Diagnostic Measures Clinical Stages Clinical Manifestations

Fluid, Electrolyte, and Acid–Base Disorders Cardiovascular Complications Gastrointestinal Disorders Disorders of Mineral Metabolism Hematologic Complications Immunologic Disorders Neuromuscular Complications Sexual Dysfunction Skin Disorders Treatment Conservative Medical Management Dietary Management Medication Management Dialysis and Transplantation Chronic Kidney Disease in Children and Elderly Persons Chronic Kidney Disease in Children Chronic Kidney Disease in Elderly Persons

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