Acute Kidney Injury in Chronic Kidney Disease

Acute kidney injury (AKI) is an increasingly common complication of acute illness that strongly associates with increased morbidity and mortality. AKI has been established as a risk factor for future development and acceleration of chronic kidney disease (CKD). Moreover, CKD patients with the most rapid progression to end-stage kidney disease (ESKD) tend to have non-linear decline in kidney function due to one or more episodes of AKI. When AKI occurs in a patient with CKD, quickly identifying reversible causes and implementing strategies to rapidly restore kidney function are imperative, as patients with CKD may be more susceptible to developing irreversible tissue damage. While treatment options for established AKI remain supportive (e.g., volume-resuscitation and avoidance of nephrotoxins), we recommend early consultation with a nephrologist when a reversible cause is not immediately apparent, in patients in whom injury is progressive with increased risk for complications that may require renal replacement therapy, or in specialized cases of AKI that may require a rapid tissue diagnosis (e.g., acute glomerulonephritis). Patients who have experienced an episode of moderate to severe AKI should be seen in follow-up within 3 months after the event to evaluate for resolution and for new onset or worsening of pre-existing CKD or development of other complications.