Acute Kidney Injury : Oliguric phase

    • Oliguric phase
      • Urinary changes- oliguria
        • Urinary output less than 400 mL/day
        • Occurs within 1 to 7 days after injury
        • Lasts 10 to 14 days
        • Urinalysis may show casts, RBCs, WBCs
      • Fluid volume
        • Hypovolemia may exacerbate AKI
        • Decreased urine output leads fluid retention
          • Neck veins distended
          • Bounding pulse
          • Edema
          • Hypertension
        • Fluid overload can lead to heart failure, pulmonary edema, and pericardial and pleural effusions
      • Metabolic acidosis
        • Impaired kidney cannot excrete hydrogen ions
        • Serum bicarbonate production is decreased
        • Severe acidosis develops
          • Kussmaul respirations
      • Sodium balance
        • Increased excretion of sodium
        • Hyponatremia can lead to cerebral edema
      • Potassium excess
        • Impaired ability of kidneys to excrete potassium
        • Increased risk with massive tissue trauma
        • Usually asymptomatic
        • ECG changes
      • Hematologic disorders
        • Leukocytosis
      • Waste product accumulation
        • Elevated BUN and serum creatinine levels
      • Neurologic disorders
        • Fatigue and difficulty concentrating
        • Seizures, stupor, coma
    • Diuretic phase
      • Daily urine output is 1 to 3 L
      • May reach 5 L or more
      • Monitor for hyponatremia, hypokalemia, and dehydration
    • Recovery phase
      • May take up to 12 months for kidney function to stabilize
  • Diagnostic studies
    • Thorough history and physical examination
    • Identification of precipitating cause
    • Serum creatinine and BUN levels
    • Serum electrolytes
    • Urinalysis
    • Kidney ultrasonography
    • Renal scan
    • CT scan
    • Renal biopsy
    • Contraindicated
      • MRI with gadolinium contrast medium
      • Magnetic resonance angiography (MRA) with gadolinium contrast medium
        • Nephrogenic systemic fibrosis
        • Contrast-induced nephropathy (CIN)
  • Management