Management of Acute Kidney Injury

  • Fadi A. Tohme
  • John A. KellumEmail author


Acute Kidney Injury (AKI) in the ICU is commonly caused by hypotension, shock, inflammation, and microcirculatory dysfunction. Reversal of shock through intravenous fluids and vasopressors while avoiding harm from volume overload is the first step in management of AKI. Ascertainment of other underlying causes such as drug or contrast induced nephrotoxicity, urinary tract obstruction or glomerular disease is important, as specific treatments of those conditions might reverse AKI. Efforts are made to prevent further injury and adjust dosage of renally excreted medications. Complications of AKI include volume overload, hyperkalemia, metabolic acidosis, hyperphosphatemia, hypocalcemia and bleeding disorders. Their management is an integral part of treating AKI. Renal replacement therapy is instituted when or preferably before complications from AKI arise despite medical management. Both intermittent hemodialysis and continuous renal replacement therapy are acceptable modalities for dialysis in AKI. Higher doses of renal replacement therapy do not seem to improve outcomes, and prophylactic use of dialysis continues to be a subject of debate. Crystalloids are the fluid type of choice. Concerns have been raised about the safety of hyperchloremic solutions such as normal saline, but more physiologically balanced solutions such as lactated Ringer’s or plasmalyte have yet to show an improvement in hard outcomes. Nutritional support and tight glycemic control in patients with AKI is important but requires further delineation.


Acute kidney injury Intravenous fluids Diuretics Dialysis Renal replacement therapy 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Nephrology DivisionWashington UniversitySt. LouisUSA
  2. 2.Critical Care Research, Center for Critical Care Nephrology, Critical Care MedicineUniversity of PittsburghPittsburghUSA

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