Acute Kidney Disease

Acute kidney disease also known as acute renal failure is a disease which happens to be associated with high mortality and morbidity. The said disease is caused by ischemia (1). Previous studies have revealed the association between ischemia and loss in NPK cells and cadherin cleavage owing to matrix metalloproteinase (MMP). One such study was conducted to identify MMP that was needed for N-cadherin loss and N-cadherin cleavage. Results showed that cadherin loss was not induced by ischemia when chemical inhibitors were put against soluble MMPs (1). In addition, there was a decrease in (MT) MMP-2 and an increase in (MT) MMP-1 under ischemic conditions. From the said results, it would be prudent to note that cadherin disruption and increased appearance of active MT1-MMP are induced by ischemia (1). In this research paper, I will explain the pathophysiology of acute kidney disease with regard to its incidence, risk factors, differential diagnosis, features, signs and symptoms, molecular basis, normal physiology and homeostasis, types, and etiology.

Epidemiology

Acute kidney disease has conventionally been classed as a nosocomial disease i.e. originating from the hospital (2). The incidence of acute kidney disease was found to be around 7% among patients who had been hospitalized. Research shows that acute kidney disease in urban areas was acquired from hospital while in the rural areas, the said disease was as a result of community acquired diseases such as dehydration and diarrhea (3). The incidence was found to be high among patients in stage III. Stage I and II had lower incidences (2). In addition, patients who are critically ill have a high prevalence of acute kidney disease. Presence of comorbidities and advanced age among patients led to an increase in incidence of acute kidney disease. Obesity, alcoholism, heart failure, heart disease, diabetes mellitus and arterial hypertension were also associated with increased incidence of acute kidney disease (2). Moreover, patients with a history of previous admission in hospital, use of contrast and medium diuretics, use of nephrotoxic drugs, proteinuria and/or hematuria, previous acute kidney disease, lithiasic and/or tumoral pathology had high chances of developing acute kidney disease. Other risk factors associated with acute kidney disease were inclusive of, but they were not limited to; respiratory disease, chronic heart disease, hypovolemia, and age (2). The rate of mortality among acute kidney disease patients was high in patients who were in the third stage of the said disease, those who were critically ill, and those who had undergone surgery.

Etiology

Nitrogenous waste products are excreted and filtrated by the kidney. An increase in the level of creatinine and blood urea nitrogen leads to a decrease in elimination of waste products which indicates a decline in renal function (3). Therefore, it is important to note that acute kidney disease occurs when nitrogenous wastes are retained owing to a decrease in glomerular filtration rate. The said decline may occur over time or in hours. However, the said decline mostly occurs in hours. Renal tissue injury is often caused by renal etiologies. Acute kidney disease may also be caused by other causes. For instance, cellular stress may lead to increased demands in energy and a focal mismatch of nutrient delivery and oxygen owing to an impaired microcirculation (4).

Types and Classification

Acute kidney disease is classed into three categories, i.e. pre-renal acute kidney disease, renal kidney disease, and post-renal kidney disease. As indicated in etiology, a decline in renal perfusion would lead to a decrease in glomerular filtrate rate. Pre-renal acute kidney injury occurs when glomerular filtrate rate has decreased owing...

…kidney disease should be evaluated in hospitalized patients. It would be prudent to check for any radiologic studies, and that entails the use of contrast agents that have been iodinated. This is more so the case given that such agents happens to be common causes of acute kidney disease (7). There would also be need to check for any medications taken by the patient that may lead to renal failure. Lab tests for acute kidney disease involves basic metabolic channel whereby the levels of urine electrolytes are measured (7). Other laboratory tests are inclusive of, but they are not limited to; creatinine to urine albumin ratios, urine osmolality, urine protein, serum and urine protein electrophoresis, renal ultrasound, CT non-contrast, kidney biopsy, and urine sediment examination (7).

Differential Diagnosis

Patients with acute kidney disease may also have chronic renal failure. Therefore, it is imperative to include a differential diagnosis for the said disease. Differential diagnosis for acute kidney disease is as follows: urinary obstruction, diabetic ketoacidosis, urinary tract infection, heart failure, gastrointestinal bleeding, dehydration, chronic renal failure, sickle cell anemia, renal calculi (7).

Complications and Prognosis

Acute kidney disease is associated with various complications which may lead to mortality. The said complications are inclusive of, but they are not limited to; hyponatremia, metabolic acidosis, volume overload, hyperkalemia, neurologic, gastrointestinal, and cardiovascular organs complications (7). Prognosis of acute kidney disease depends on the cause. For instance, pre-renal cases often recover if detected early. It is important to note that renal function may worsen owing to repeated acute kidney disease. It is also important to follow-up with patients to ensure renal function has been normalized. Other factors to consider during prognosis are inclusive of, but they are not limited to; number of transfusions, sepsis, multi-organ involvement, inotropic support, decline in…