a) Discuss need for long term follow-up of AKI (acute kidney injury) cases. [4] b) Prevention of AKI in ICU (Intensive Care Unit). [3] c) Stage of renal angina in progress of AKI. [3]
Acute Kidney Injury (AKI) is a sudden decrease in kidney function, manifested by rise in serum creatinine and/or reduction in urine output, occurring over hours to days. Long-term follow-up of AKI patients is crucial as many develop chronic kidney disease (CKD) or end-stage renal disease (ESRD) despite apparent recovery (Harrison's 21e, Ch. 265).
AKI pathophysiology involves abrupt impairment of glomerular filtration due to ischemic, nephrotoxic, or inflammatory insults. Post-AKI, incomplete repair with persistent fibrosis, capillary rarefaction, and tubular atrophy contributes to CKD progression.
| Mechanisms of AKI Progression to CKD | Description |
|---|---|
| Tubular injury and maladaptive repair | Tubular epithelial cell death and insufficient regeneration |
| Microvascular rarefaction | Loss of peritubular capillaries causing chronic hypoxia |
| Interstitial fibrosis and inflammation | Activation of fibroblasts and inflammatory cells |
| Cellular senescence and maladaptation | Persistent senescent cells worsen injury |
Renal angina concept preliminarily identifies high-risk AKI patients for preventive strategies (Brenner & Rector’s The Kidney, 11th edition).