Acute Kidney Injury and Chronic Kidney Disease Management

Definitions and Diagnostic Approaches

• The Kidney International guideline defines Acute Kidney Injury (AKI) as a rapid increase in serum creatinine or decreased urine output, and Chronic Kidney Disease (CKD) as kidney dysfunction persisting for more than 3 months 1, 2, 3, 5
• Acute Kidney Disease (AKD) bridges AKI and CKD, representing kidney dysfunction present for 7 days to 3 months 3, 4

Management Priorities

• The Kidney International guideline recommends discontinuing nephrotoxic agents when possible, ensuring appropriate volume status and perfusion pressure, and monitoring serum creatinine and urine output closely for AKI patients 2
• For CKD patients, the Kidney International guideline suggests focusing on cause-specific classification with GFR and albuminuria staging, implementing long-term strategies to slow progression, and considering ACEi or ARB therapy for patients with hypertension and proteinuria 5, 6

Transitional Management and Follow-up

• As GFR stabilizes after AKI, the Kidney International guideline recommends transitioning from AKI-based staging to GFR-based categories 5, 6, 7
• The Kidney International guideline suggests considering using measured GFR rather than estimated GFR when kidney function is changing rapidly, and monitoring for maladaptive repair mechanisms that may accelerate progression to CKD 5, 7

Common Pitfalls to Avoid

• Failing to adjust medication dosing during the transition from AKI to CKD, and overlooking the bidirectional relationship between AKI and CKD 2, 8
• The Kidney International guideline warns against using dual RAAS blockade, which increases hyperkalemia and AKI risk 8