Complications
A late complication usually arising several days after glomerular filtration falls.
Treatment includes dietary restriction and the administration of phosphate binders, such as calcium acetate, calcium carbonate, sevelamer, or lanthanum carbonate.
Haemodialysis is effective in phosphorus reduction. In patients in whom intense renal replacement is undertaken, such as those on continuous renal replacement therapies or daily dialysis regimens, phosphorus replacement may be required.
Uraemic toxins accumulate with severe and untreated kidney failure, resulting in lethargy, confusion, and obtundation.
Dialysis is required for management of uraemia.
Results from impaired excretion of potassium, cell lysis, or tissue breakdown.
Severe hyperkalaemia may result in muscle weakness and classic ECG findings of peaked T waves, increased PR interval, widened QRS, atrial arrest, and deterioration to a sine wave pattern.
If hyperkalaemia is confirmed or suspected, use normal saline (0.9% sodium chloride) rather than a balanced crystalloid for fluid balance.[177]
Treatment depends on the severity and presence of muscular and/or cardiac complications. Check your local protocols - many hospitals have institutional guidelines for managing hyperkalaemia.
See the Treatment algorithm section of this topic for information on managing mild, moderate and severe hyperkalaemia.
AKI may leave the patient with prolonged kidney damage, and functional recovery may not return to the baseline.
Recovery is dependent on the mechanism and severity of the injury and the underlying comorbid medical conditions.
AKI in children may be associated with chronic kidney disease that may progress to end-stage kidney disease.[178][179]
Patients with partial or no recovery from AKI are at increased risk for congestive heart failure and acute myocardial infarction.[180][181]
Some patients may not recover from severe kidney injury, especially those with underlying kidney disease or other comorbid medical conditions. Chronic renal replacement therapy may be required.[172]
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