Acute Kidney Injury in Adults: An Underdiagnosed Condition

Kristy Washinger; MSN; FNP-BC

Disclosures

Journal for Nurse Practitioners. 2017;13(10):667-674. 

In This Article

Types

The types of AKI are divided into 3 categories: prerenal, intrarenal, and postrenal. Prerenal is caused by a sudden and severe drop in blood pressure, interruption of blood flow to the kidneys from severe injury or illness, and/or volume depletion. Prompt correction of the underlying cause will usually result in rapid correction of blood flow, which will prevent permanent kidney damage. Intrarenal is caused by direct damage to the kidneys by inflammation, toxins, drugs, sepsis, or reduced blood supply. The damage affects 1 of the compartments of the renal parenchyma (vasculature, glomerulus, tubules, or interstitium). The most common causes of intrarenal are acute tubular necrosis (ATN), contrast-induced nephropathy, and acute interstitial nephritis (often inflammatory). Postrenal is caused by an obstruction of urine flow or injury. The obstruction can be partial, complete, unilateral, or bilateral and can affect the upper tract (renal pelvis and ureters) or the lower tract (bladder or urethra). A partial obstruction can cause polyuria or oliguria, whereas a complete obstruction causes anuria. The most common complication of an obstruction is a urinary tract infection, but permanent kidney damage can also occur from obstruction (Table 2).[9]

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