SEARCH RESULTS FOR: Post-Renal-Acute-Kidney-Injury-AKI

Post-Renal Acute Kidney Injury AKI

Post-Renal Acute Kidney Injury (AKI): Pathogenesis and clinical findings
          Blood clot or cellular debris
Foreign body
Neurogenic bladder
Obstruction intrinsic to urine excretion system
Nephrolithiasis (kidney stones)
Anatomical defect(s)
Intra- abdominal adhesions
Retroperitoneal fibrosis (scar-like tissue)
Benign or malignant masses
Prostate cancer
Benign prostatic hyperplasia
      ↓ Urine flow across point of obstruction Obstruction extrinsic to urine excretion system
         Urine buildup distends urine collecting system (hydronephrosis)
Compression of renal vasculature due to mass effect
↑ Volume/pressure proximal to obstruction
↑ Intratubular pressure
↓ Pressure gradient between glomerular afferent arteriole and Bowman’s space
Casts occlude tubules
↓ Filtration of plasma into nephrons
↓ Glomerular Filtration Rate (GFR)
Obstruction is relieved ↓ Intratubular pressure Rapid GFR ↑
Rapid diuresis of fluid and electrolytes
  Dilated pelvicalyceal system on ultrasound
↓ Urine output
          ↓ Venous drainage
and arterial supply
Local ischemia and inflammation of kidney
Impaired resorption, excretion, and fine tuning by tubules
Acute Tubular Necrosis (ATN) with granular casts
     ↓ Urine output
↓ Clearance of free water and solutes
↑ Intravascular volume
↑ Serum creatinine
↓ Medullary solute concentration, ischemia, ↓ response of collecting ducts to antidiuretic hormone
Lasts > 24hrs
Post-obstructive diuresis causes hypovolemia and electrolyte derangements
Authors: David Campbell, Matthew Hobart Reviewers: Raafi Ali, Luiza Radu Huneza Nadeem, Marissa Zhang, Julian Midgley* * MD at time of publication
Resolves < 24hrs in euvolemia
Physiologic post- obstructive diuresis
            ↑ Na+ and Cl- delivery to distal convoluted tubule is sensed by macula densa
Secretion of adenosine by macula densa
Adenosine constricts afferent arterioles
↓ GFR
↓ Renal clearance of drugs and waste products
       ↑ Venous hydrostatic pressure
↑ Volume in arterial system overwhelms pressure regulation mechanisms
Hypertension
   Fluid extravasation from veins and capillaries
   Generalized Edema
 Legend:
 Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
 Complications
 Published Mar 25, 2024 on www.thecalgaryguide.com