Abstract
Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.
Highlights
Acute kidney injury (AKI) is a complex syndrome that is much more than a simple severity marker
Due to the nature of their pathologies, patients suffering from urinary tract disorders who attend urology have an increased risk of experiencing AKI, and they are almost always elderly individuals or patients with urinary sepsis [4, 5]. ough AKI caused by Obstructive nephropathy (ON) (AKI-ON) has a more benevolent clinical evolution than other causes of AKI, such as sepsis [6], cardiac surgeries [7], or nephrotoxicity [8], there is, a significant association with prolonged hospital stays, decreased kidney recovery, and a greater chance of death [4], when compared with individuals who do not suffer from AKI-ON
In a cohort study involving patients suffering from urinary tract disorders who attend urology, it was reported that AKION represented 46.5% of urgent-care cases, when quantifying these numbers through AKIN stages, 89.7% were in stage 1, 5.2% in stage 2, and 3.4% were in stage 3
Summary
Acute kidney injury (AKI) is a complex syndrome that is much more than a simple severity marker. It affects all of the systems, and it can lead to multiorgan failure; it has a profound biological impact in those afflicted by it. Due to the nature of their pathologies, patients suffering from urinary tract disorders who attend urology have an increased risk of experiencing AKI, and they are almost always elderly individuals or patients with urinary sepsis [4, 5]. We assess the etiologies, physiopathological mechanisms, and treatments that result in glomerular and tubular alterations that can lead to AKI-ON
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