Download Acute kidney injury (AKI)

Acute kidney injury (AKI)
This leaflet offers more information about acute kidney injury, including what it is, how it
is diagnosed, and how it can be treated. If you have any further questions or concerns,
please speak to the staff member in charge of your care.
Where are the kidneys and what do they do?
Kidneys are bean-shaped organs, which are about 10cm in length in adults. Most people have
two kidneys located in the upper part of the abdomen (tummy) on either side of the spine (see
Figure 1).
Figure 1
Kidneys have several important functions including:
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filtering waste products from the blood
removing excess fluid from the body
controlling blood acidity
regulating salt levels in the body (which helps control blood pressure)
regulating the production of red blood cells.
Your urine (wee) is the product of the excess fluid and waste products that are filtered through
the kidneys. Urine passes from the kidneys down into your bladder via tubes (called ureters) that
connect them. Your body will normally sense when your bladder is full and tell you that you need
to pass urine (go to the toilet).
What is acute kidney injury?
Acute kidney injury (AKI) is a condition where your kidneys stop working properly. AKI typically
occurs when you are unwell with another illness, such as an infection, and may require you to be
admitted to hospital or seen in clinic.
The earlier AKI is identified and managed, the better the chances of your kidneys recovering.
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What causes AKI?
AKI most commonly occurs when the blood supply to the kidneys decreases. This can happen in
cases of severe dehydration, severe infection, severe heart or liver disease, or after major
surgery or trauma.
AKI may also occur following direct damage to the kidneys from certain medications or a rare
inflammation in the kidneys known as glomerulonephritis.
Finally, AKI can be caused by a blockage to the kidneys’ draining system.
What happens when you have AKI?
Most of the time, AKI is mild with no symptoms and corrects itself over a short period of time.
Sometimes, however, AKI is severe, resulting in the accumulation of excess waste products in
the blood. In addition, the kidneys may stop regulating your body’s salt and water, leading to
swelling of the legs and a build-up of fluid in the lungs. These changes can make you feel
generally unwell, breathless and (in severe cases) can cause an abnormal heart rhythm.
How is AKI diagnosed?
Kidney function is assessed by measuring a substance called creatinine in the blood. Creatinine
is produced by the muscles at a fairly constant rate and is removed by the kidneys. If your
kidneys are not functioning properly, your creatinine levels will rise. The higher your creatinine
levels, the worse your kidney function is likely to be.
To help monitor kidney function we also record the amount of urine produced by your kidneys.
Sometimes this involves placing a catheter (a soft plastic tube) into your bladder to drain your
urine.
We will ask you and your relatives for a full history of your symptoms, previous illnesses and any
medications you are taking. We will then examine you fully, performing some standard
investigations, including blood and urine tests. An ultrasound scan of the kidneys may be
required to make sure that the kidneys look normal and that the urine flow is not blocked.
Very rarely, we may need to take some tissue directly from the kidneys for examination under a
microscope. This is a very simple procedure called a kidney biopsy. Having a biopsy will be
discussed with you in more depth should it be required.
How is AKI treated?
To treat AKI, we need to treat the underlying cause. This means that treatment will vary from
patient to patient.
If there is evidence of dehydration, we may give you fluids through a cannula (a needle in your
arm or hand that is connected to a drip).
We will review all medications that you are taking and will stop or adjust the doses of some of
them if they could be causing or contributing to your AKI.
In cases of severe kidney injury, dialysis might be required. Dialysis is a technique that removes
toxic substances that accumulate in the blood and regulates the levels of salt and fluid in the
body. Dialysis is only necessary for a minority of AKI patients and further information will be
provided for those that require it.
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What are the long-term effects of AKI?
If you have had AKI, you will need to be followed up by your medical team (or your GP) to ensure
your kidney function improves. Some patients develop a degree of scarring in the kidneys after
AKI and need to be seen regularly in a specialist kidney clinic.
A small amount of patients with severe AKI may suffer incurable kidney damage and may need to
continue having dialysis. These patients may need to be considered for kidney transplantation.
Contact us
If you have any questions or concerns about acute kidney injury, please contact us on 020 8725
6092 (Monday to Friday, 9am to 5pm).
For more information leaflets on conditions, procedures, treatments and services offered
at our hospitals, please visit www.stgeorges.nhs.uk
Additional services
Patient Advice and Liaison Service (PALS)
PALS can offer you on-the-spot advice and information when you have comments or concerns
about our services or the care you have received. You can visit the PALS office between 9am
and 5pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough Wing
(near the lift foyer).
Tel: 020 8725 2453 Email: [email protected]
NHS Choices
NHS Choices provides online information and guidance on all aspects of health and healthcare,
to help you make decisions about your health.
Web: www.nhs.uk
NHS 111
You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is
available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones.
Tel: 111
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Reference: GME_AKI_01
Published: July 2015
Review date: July 2017