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Intra-renal acute kidney injury — Clinical Guidelines

Overview

Intra-renal acute kidney injury (AKI) refers to sudden damage to kidney tissues, often indicated by functional impairment and biomarker alterations, potentially arising from various etiologies including trauma, pharmacological effects, and strenuous physical activity. 3 5 7

Diagnosis

Key Diagnostic Criteria: Microscopic hematuria, proteinuria, and elevated biomarkers such as NAG and beta-2 microglobulin.

Recommended Tests: Urinalysis for hematuria and proteinuria; serum creatinine and estimated glomerular filtration rate (eGFR) monitoring; urinary NAG and beta-2 microglobulin levels.

Grading: Utilize RIFLE (Risk, Injury, Failure, Loss, End-stage renal failure) or AKIN (Acute Kidney Injury Network) criteria for staging severity. 7

Management

First-line Treatments: Address underlying cause (e.g., cessation of nephrotoxic drugs, management of trauma).

Fluid Management: Maintain adequate hydration, possibly with diuretics if indicated.

Monitoring: Frequent assessment of renal function parameters and clinical status.

Adjunctive Therapies: No specific drug doses mentioned; supportive care tailored to underlying cause. 7

Special Populations

Pediatrics: Bone marrow-derived cell regeneration noted in a pediatric case post-transplant, suggesting potential regenerative capacity. 6

Elderly: Increased susceptibility to AKI from nephrotoxic agents and trauma; careful monitoring of renal function post-procedures like ESWL. 1

Comorbidities: Patients on antiplatelet agents or with arterial hypertension may face heightened risk post-procedural complications (e.g., renal hematoma). 1

Key Recommendations

Monitor Biomarkers: Regularly assess urinary NAG and beta-2 microglobulin levels to detect early tubular injury (Evidence: Moderate) 7

Evaluate Underlying Causes: Promptly identify and manage the root cause of AKI, whether traumatic, pharmacological, or related to strenuous activity (Evidence: Moderate) 3 5

Supportive Care: Implement supportive measures including fluid management and close clinical monitoring, especially in high-risk groups like the elderly and those with comorbidities (Evidence: Expert opinion) 1 6

References

1 Elizalde-Benito FX, Elizalde-Benito ÁG, Urra-Palos M, Elizalde-Amatria AG. Cutaneous manifestation of renal hematoma after ESWL. Archivos espanoles de urologia 2013. link 2 Suissa S, Henry D, Caetano P, Dormuth CR, Ernst P, Hemmelgarn B et al.. CNODES: the Canadian Network for Observational Drug Effect Studies. Open medicine : a peer-reviewed, independent, open-access journal 2012. link 3 Bernard JJ. Renal trauma: evaluation, management, and return to play. Current sports medicine reports 2009. link 4 Emeigh Hart SG. Assessment of renal injury in vivo. Journal of pharmacological and toxicological methods 2005. link 5 Holmes FC, Hunt JJ, Sevier TL. Renal injury in sport. Current sports medicine reports 2003. link 6 Nishida M, Kawakatsu H, Shiraishi I, Fujimoto S, Gotoh T, Urata Y et al.. Renal tubular regeneration by bone marrow-derived cells in a girl after bone marrow transplantation. American journal of kidney diseases : the official journal of the National Kidney Foundation 2003. link 7 Ishikawa M, Yamashita K, Shimizu T. Studies of enzymuria and beta 2-microglobulinuria in patients receiving prophylactic cefotaxime in obstetric and gynaecological surgery. Drugs 1988. link 8 Daughtry JD, Rodan BA, Bean WJ. Pneumocalyx following percutaneous nephrostolithotomy. Urology 1986. link90007-5) 9 Lalude AO, Martin DC. Renal arteriovenous fistula: a complication of anatrophic nephrolithotomy. The Journal of urology 1983. link51441-x) 10 Boileau M, Fuchs E, Barry JM, Hodges CV. Stress hematuria: athletic pseudonephritis in marathoners. Urology 1980. link90007-2) 11 Gawlik Z, Molak-Olczakowa H, Wasiutyński A, Kruś S. Renal glomerular and tubular lesions in rabbits treated with uranyl nitrate. Polish medical sciences and history bulletin 1976. link

Intra-renal acute kidney injury