Acute Kidney Injury
Rapid Expert Response to Kidney Events

Acute kidney injury (AKI) — previously called acute renal failure — is a rapid decline in kidney function occurring over hours to days, resulting in the buildup of waste products in the blood, fluid retention, and electrolyte imbalances. AKI is not a single disease but a clinical syndrome with many different causes, each requiring a specific diagnostic and therapeutic approach.

AKI is increasingly common in hospitalized patients and significantly increases the risk of short-term complications (including need for dialysis), long-term CKD development, cardiovascular events, and death. Prompt nephrology consultation is critical to optimizing outcomes and identifying reversible causes before permanent damage occurs.

Even in patients who appear to recover from AKI, careful follow-up nephrology care is essential — studies show that a significant proportion develop permanent CKD or recurrent AKI without adequate monitoring and protective interventions in the recovery phase.

Our nephrologists use a systematic framework to classify AKI and identify its cause — a critical step because the treatment differs dramatically depending on etiology:

Pre-renal AKI results from reduced blood flow to the kidneys due to dehydration, heart failure, sepsis, or excessive diuresis. Treatment focuses on restoring perfusion and addressing the underlying cause.

Intrinsic renal AKI involves direct damage to kidney structures — the tubules (as in acute tubular necrosis from ischemia or nephrotoxins), the glomeruli (acute glomerulonephritis), the interstitium (acute interstitial nephritis from medications or infections), or the vasculature. Accurate diagnosis often requires urinalysis with microscopy, targeted blood tests, and sometimes kidney biopsy.

Post-renal (obstructive) AKI results from urinary tract obstruction and is often rapidly reversible once the obstruction is relieved — but requires prompt recognition with imaging and urology consultation.

Contrast-induced and drug-induced AKI are common and preventable. We work with referring physicians on prevention protocols and provide management for patients who develop AKI despite precautions.

For patients who develop severe AKI with life-threatening complications — including refractory hyperkalemia, pulmonary edema, severe metabolic acidosis, or uremic symptoms — acute kidney replacement therapy (KRT) may be lifesaving. Our nephrologists oversee the initiation and management of acute hemodialysis, guiding the complex decisions around timing, modality, and dose of KRT.

Equally important is the post-AKI period. Patients who have experienced AKI — even those who appear to have fully recovered — are at significantly elevated risk for CKD, recurrent AKI, hypertension, and cardiovascular events. We provide dedicated post-AKI follow-up to monitor kidney function recovery, identify persistent impairment, address contributing risk factors, and reduce the risk of long-term complications.