Acute Kidney Injury
Treatment and Prognosis of AKI
Lyz Boyd
Learning Objectives
By the end of this chapter, you will be able to:
- Explain why addressing the underlying cause will ultimately treat the acute kidney injury
- Briefly describe the process of dialysis to treat AKI
You may be wondering, once a patient has developed AKI, what happens? This section will address the treatment and prognosis of AKI.
Treatment
As we’ve seen so far in this chapter, the causes of AKI are widely varied. Therefore, the treatments also vary and are aimed at addressing the underlying cause of the AKI as well as managing some of the symptoms. Here are some examples of treatments for the different types of causes of AKI:
| Type of AKI | Example pathology | Examples of treatment strategies |
| Prerenal | Hemorrhagic shock | Surgery to control the source of the bleeding, replacement of blood volume with IV fluids and/or blood transfusion |
| Intrarenal | Acute streptococcal glomerulonephritis | Administration of antibiotics to treat the bacterial infection and of medications to decrease blood pressure if elevated. Immunosuppressive medications lack evidence for this condition, but they may be used if the condition is severe or worsening based on kidney biopsy. |
| Postrenal | Obstruction of the urethra caused by BPH | Insertion of a catheter into the urethra to keep it open and relieve the obstruction. |
If the kidney dysfunction is severe enough that the patient experiences dangerous imbalance in pH or electrolytes or build up of waste products, dialysis may be necessary. Dialysis is a process that uses a machine to mimic the function of the kidney outside the body. During the process, the patient’s blood is passed along a membrane that mimics the function of the glomerulus and allows waste products to be removed from the blood by passing through a semipermeable membrane. The blood is then returned to the patient. While this is a life-saving treatment, it is not perfect and does not entirely mimic the function of the kidneys. It is also a time-consuming procedure that needs to be performed every 2-3 days.
Prognosis
Just as the causes and treatments vary, the anticipated long term outcomes of AKI vary as well. The severity and cause of the AKI have a large impact on the prognosis.
As we’ve seen in some of the cases presented throughout previous sections, death is unfortunately a relatively common outcome of AKI. Sometimes the AKI itself is responsible for the death of the patient, but in many cases the serious illness that causes the AKI, such as a patient being in medical shock, causes both the AKI and the patient’s death.
Many patients survive, but still have some impairment of their kidney function and become part of the population who has chronic kidney disease (CKD). CKD can vary widely in severity, from requiring only medications and dietary restrictions to manage it to requiring ongoing dialysis or even renal transplant.
Some patients make a full recovery after the underlying cause of the AKI has been treated. Some of these patients may require dialysis temporarily while their kidney function recovers.
Section Summary
The treatments and prognoses of AKI are just as varied as the causes of AKI. The treatments aim to address the underlying cause and/or treat the symptoms. Some patients unfortunately pass away as a result of AKI or the cause of the AKI and others live with ongoing impairment of their kidney function. However, some patients do make a full recovery.
