AKI Etiology

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Approximately 70% of community-acquired cases of acute kidney injury are attributed to pre-renal causes. In most of these cases, the underlying kidney function may be normal, but decreased renal perfusion associated with low intravascular volume or decreased arterial pressure can determine a reduced glomerular filtration rate (GFR). Autoregulatory mechanisms can partially compensate renal perfusion reduction in order to maintain GFR. In patients with pre-existing chronic kidney disease, however, these mechanisms are impaired, and the susceptibility to develop acute-on-chronic renal failure is higher...

The incidence of acute kidney injury related to urinary tract obstruction is low (1-10%). It occurs in bilateral renal or lower urinary tract obstruction or in ureter obstruction in patients with a single functioning kidney or with pre-existing chronic kidney disease. The etiology and the incidence of obstruction vary on the basis of age and gender. Conventional ultrasound has a high sensitivity (>95%), but low specificity (<70%) in the diagnosis of urinary tract obstruction. Nevertheless, color Doppler is used through the evaluation of renal resistive indexes, ureteral jet and twinkling artifact...

Acute cortical necrosis and hemolytic uremic syndrome (HUS) are 2 clinical scenarios of parenchymal acute kidney injury (AKI) related to renal microvascular injury. Acute cortical necrosis is a rare condition related to an ischemic necrosis of renal cortex. Necrotic lesions can be due to several injuries and may be focal, multifocal or diffuse. Renal necrotic lesions become visible with ultrasound only after renal recovery. HUS is a rare disease characterized by hemolytic anemia, thrombocytopenia and AKI. Color Doppler ultrasound is useful during diagnostic and follow-up phase...

Acute tubular necrosis (ATN) is the most common type of acute kidney injury (AKI) related to parenchymal damage (90% of cases). It may be due to a direct kidney injury, such as sepsis, drugs, toxins, contrast media, hemoglobinuria and myoglobinuria, or it may be the consequence of a prolonged systemic ischemic injury. Conventional ultrasound (US) shows enlarged kidneys with hypoechoic pyramids. Increased volume is largely sustained by the increase of anteroposterior diameter, while longitudinal axis usually maintains its normal length...

Acute kidney injury (AKI) is a common complication following orthotopic liver transplantation. It is associated with increased morbidity and mortality, as well as increased healthcare costs. The aetiology of AKI post liver transplantation is multifactorial and understanding these factors is pivotal in developing risk stratification and prevention strategies. This study aims to investigate the preoperative and intraoperative factors that may be associated with AKI in patients undergoing liver transplantation at the Princess Alexandra Hospital, Brisbane, Queensland...

Renal cortical necrosis (RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome (HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis...