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Acute Kidney Injury

Acute kidney Injury (AKI) refers to a quick decrease in kidney function. AKI is often the result of sudden health problems such as infections, dehydration, or the effects of certain medications. AKI affects up to 20% of people who are admitted to the hospital, and many cases start in the community outside of hospital settings. 

Patients who develop an AKI are at higher risk of developing chronic kidney disease, recurrent AKI, cardiovascular disease, hypertension, and stroke.  Strategies to prevent, recognize, and manage episodes of AKI are critical. Furthermore, follow up with a healthcare provider, lab testing, and medication review after episodes of AKI can enhance patient well-being and reduce the chances of future health problems.  

About AKI

 
  • The kidneys perform many important functions, including filtering the blood to remove toxins, regulating salt, water, electrolytes, and acidity, and removing drugs and medications from the body. Additionally, the kidneys produce hormones that help with bone health and the production of red blood cells.   

 
AKI is a sudden loss of kidney function. It is typically caused by other health conditions or events that reduce blood flow or oxygen to the kidneys. It can also be caused by medications or other substances that are toxic to the kidneys, or that cause a prolonged blockage of urine flow.
 
Causes of AKI include:  
  • Infection. 
  • Blood or fluid loss 
  • Medications (such as non-steroidal anti-inflammatory drugs (NSAIDs)) which are used to reduce swelling or relieve pain from headaches, colds, flu, and other ailments. These include ibuprofen [Advil, Motrin], ketoprofen, and naproxen [Aleve].  
  • Heart attack, heart failure, and other conditions leading to decreased heart function
  • Severe allergic reactions
  • Major surgery 
  • Blockage of urine flow (ex: prostate disease, kidney stones, and tumours)
  • Kidney diseases (ex: glomerulonephritis) 
AKI Symptoms 
Patients with AKI often don’t experience any symptoms unless it is severe. Signs and symptoms of AKI will differ depending on the causes and may include: 
  • Little or no urine output
  • Swelling in legs, ankles, or feet
  • Fatigue or tiredness
  • Shortness of breath 
  • Confusion
  • Loss of appetite, nausea, or vomiting
  • Seizures or coma in severe cases
Diagnosing AKI 
AKI is often diagnosed during a hospital stay for another issue or condition. It can be identified through blood tests, urine tests, and sometimes imaging (such as ultrasound or CT).

AKI may also be diagnosed in the outpatient setting based on blood and urine tests. These tests will usually be requested when there is a reason to suspect AKI such as an illness or severe dehydration. 

 
When AKI occurs, the kidneys may have trouble getting rid of toxins and excess fluids from the body. This causes waste and fluids to build up, which can become harmful. Treatment for AKI varies depending on the severity and the cause of the kidney injury. Treatment options include: 
  • Intravenous (IV) fluids which are injected into veins through an IV to help treat AKI that is caused by a lack of fluids.  
  • Starting medications that reduce excessive swelling, control blood pressure, or control blood potassium.  
  • Stopping medications that could have caused the AKI or that may be hurting the kidneys.  
  • Adjusting medication doses that are cleared out of the body by the kidney. 
  • Treating any blockage in urine flow, such as a urine catheter or even a procedure/surgery. 
  • Dialysis may be required in severe cases of AKI to help remove toxins and excess fluids from your body while your kidneys recover.  

 
Some medications may need to be paused or reduced when you are recovering from AKI. Talk to a family doctor and pharmacist within a month of hospital discharge to ensure you know which:  
  • Medications you need to pause.  
  • Medications you need to take at a lower dose. 
  • When you can go back on medications or when/if you can go back to your regular dose for certain medications. 
Do not take any non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), unless your doctor says it is safe for you to do so.  

 
After experiencing AKI, some individuals may see full or partial recovery of kidney function, depending on factors such as the cause of the AKI, how quickly treatment was received, and other existing health conditions. Recovery is also possible for those who needed temporary dialysis during their treatment. 

Regardless of the level of recovery, AKI can have lasting health effects, increasing the risk of:   
  • Recurrent AKI episodes  
  • Hospital re-admissions
  • Progression to chronic kidney disease  
  • Development of heart problems
It is important to follow up with a family doctor or nurse practitioner following AKI within a month of hospital discharge. Your healthcare provider will run blood and urine tests to check your kidney health, monitor your blood pressure, and assess your medications.

 

How much should I eat after an acute kidney injury?

If you have lost weight, it is good to try to eat a little more to help your body recover faster.  Try to find foods you enjoy.  Weigh yourself regularly to see if you are eating enough or getting the right amount of nurtrients.  If you are still losing weight or having a hard time getting back to your regular weight, you may need to add nutrition supplement drinks such as Ensure or Boost. 
 
Is there anything I shouldn’t eat after an acute kidney injury? 
NutritonFacts-AKI.pngWhile there are no specific foods you need to avoid, being aware of how much salt you are eating is important as this may affect blood pressure and kidney health. Remember to read food labels to find out an item's sodium content.  If a food item has more than 15% Daily Value on the label, consider it a high salt food and try to limit it once per week. 

To find out more about your sodium consumption (and where it's coming from), check out this website:
For more information about dietary sodium:
Do I need to eat less potassium?
You only need to eat less potassium if you have been told that your blood potassium levels are too high. Ask your doctor if you aren’t sure. If you need to reduce the amount of potassium you eat, check out this handout:  
Do I need to eat less phosphorus? 
You only need to eat less phosphorus if you have been told that your blood phosphorus levels are too high. Ask your doctor if you aren’t sure. If you do need to eat less phosphorus, check out this handout:
Where can I get more information? 
For more dietary tips and kidney-friendly recipes, check out: https://www.kidneycommunitykitchen.ca/
 
Consultation with a dietitian may be helpful to optimize your nutrition after AKI. If you don’t already have a dietitian, consider the following options: 
  1. Ask a family doctor for a referral to a dietitian.
  2. Go to Health Link 8-1-1 for general nutrition information and private practice dietitian directory - https://www.healthlinkbc.ca/health-services/healthlink-bc-811-services/dietitian-services 
  3. Seek private practice dietitian services (some may be covered under private insurance plans) 

Resources


 
Changes in mental health are common following serious illness and hospitalization, as well as in patients living with chronic diseases. It is normal to experience feelings of stress, anxiety (worry, fear) or depression (low mood, sadness). You may get negative thoughts or have bad memories of being in the hospital. Your mood might also be affected by feelings of frustration about not being able to return to the daily activities that are important to you. Managing stress, difficult emotions, and your overall mental health are an important part of your recovery. Below are several tips and resources that can guide you in your recovery towards mental wellness. 
  1. Sleep - Get enough quality sleep by:  
    • Maintaining a regular routine and time for sleeping and waking.  
    • Making sure your living space is best for a deep sleep (i.e. limit distractions like noise and light, aim for a cool yet comfortable temperature)  
    • Reducing caffeine or nicotine in the hours before bed. 
    • Unplugging from electronics for an hour before bed to reduce stimulation 
    • For more information on insomnia and best sleep practices, check out: 
  2. Relaxation techniques - Relaxation techniques can help mental health – consider meditation, mindfulness, grounding, guided imagery/visualization, baths, aromatherapy, Tai Chi, yoga, progressive muscle relaxation and more. 
  3. Social Connection - Staying socially connected is important for mental well-being. Talking with others can help to reduce stress and provide you with support. This can take the form of a short phone call or video chat with someone you trust or connecting with others experiencing similar things in a support group. 
  4. Healthy eating - Healthy eating is important for your recovery and wellbeing. Try to eat regular and balanced meals. If you'd like to speak with a registered dietitian for guidance, you can call 8-1-1.
  5. Physical activity - Keeping physically active is important for your mental wellbeing, as well as your physical recovery. 
Recovering from an illness can be an uphill journey, and low mood can make it feel like you are carrying a heavy backpack on that journey. Talking about what you are experiencing can be very valuable. It can help those close to you understand what you’re going through, and help you unpack that heavy backpack weighing you down. You may also find it helpful to share something positive that has happened in you day. Reflecting on the things we are grateful for each day can be a very effective way to improve mental wellbeing. 

Web Resources: 
Videos for meditation & relaxation:  
Mobile Apps (free for iOS & Android devices) - Be sure to select/enable notifications/reminders if available!  
  • Mindshift CBT (Anxiety focus)  
  • Breathr App 
Access to counselling and other supports: 

 
Some patients may develop chronic kidney disease following AKI. This means their kidney function remains reduced for more than 3 months.  For patient information about chronic kidney disease, we recommend the following link: 

 
 

Almost Everything You Need to Know About Your Kidneys" (Animated Infographic for the Think Kidneys Public Campaign):  

Infographic from Think kidneys UK "Everything you need to know about your kidneys." 


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