"improving intensive care in Scotland"

Acute Kidney Injury Part 1:

Functions of the Kidney 


  • Maintenance of fluid balance
  • Regulation of sodium, potassium, phosphate concentrations
  • Excretion of metabolic waste products: urea, creatinine, ammonia, uric acid
  • Maintenance of normal acid-base balance
  • Drug and toxin metabolism and elimination


  • Erythropoietin production
  • Vitamin D and calcium metabolism: activation of 25-OHcholecalciferol
  • Renin-angiotensin system



Failure of these systems

Failure of these systems results in a number of abnormalities. The patient’s volume status and blood pressure will be determined by their fluid intake and output. In intensive care AKI is most commonly due to shock, toxins and is part of mutiple organ failure. Commonly there is salt and water depletion and hypotension. In ‘isolated’ renal failure due to glomerulnephritis or vasculitis there is commonly salt and water excess accompanied by hypertension.

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