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Acute Kidney Injury: Causes, Treatment, and Prevention

7 Minute Read
Close-up of man's hands holding an illustration of a pair of kidneys

Acute kidney injury, when the kidneys suddenly stop working properly, impacts many with diabetes. Here’s what to know about the condition, which is usually reversible.

Key takeaways: 

  • Acute kidney injury (AKI) is a sudden decline in kidney function.
  • The condition is different from chronic kidney disease (CKD), but occurs more frequently in CKD and is often a complication of diabetes; diabetes is also a risk factor for AKI. 
  • Treatment for acute kidney injury may include increasing fluids, balancing electrolytes, and stopping any medications that might be causing the AKI. 

Acute kidney injury probably sounds like something uncommon, like a contusion that’s occurred when you’ve taken a literal beating to your mid-back. In reality, it has a higher-than-average occurrence in people with diabetes. The condition is estimated to affect more than 13 million people worldwide each year.

Acute kidney injury or AKI refers to a sudden disruption in kidney function. The condition can range in seriousness; some episodes of AKI are minor and temporary, and others cause permanent total kidney failure.

The connections between diabetes and acute kidney injury are varied. There are multiple underlying causes of AKI, including diabetes complications that can be risk factors, but being aware of common symptoms, underlying causes, and screening options can help reduce your risk of acute kidney injury.

What is acute kidney injury? 

Acute kidney injury is the term used when your kidneys suddenly stop working properly. While it also describes a condition of impaired kidney function, AKI is different from chronic kidney disease (CKD), a diabetes-related complication that occurs when kidneys gradually lose function over a long period of time. Unlike CKD, AKI is the sudden loss of your kidneys’ ability to function within a few days to weeks.

Who’s at risk, and does having diabetes increase your risk of AKI?

“People living with diabetes are more likely to have an acute kidney injury,” said Dr. Sylvia Rosas, a physician at the Joslin Diabetes Center and director of the Latino Kidney Clinic. 

Because acute kidney injury can be a complication of diabetes, diabetes is a risk factor for developing AKI.

People with diabetes may have an even higher risk for developing AKI if: 

  • They have chronic kidney disease
  • They have heart disease
  • They are taking medications that can cause AKI
  • They have had AKI in the past

Research has found that experiencing acute kidney injury triples the risk of advanced chronic kidney disease in people living with diabetes. 

In addition, when a person with diabetes has AKI, they are more likely to have a severe episode and need temporary dialysis, Rosas said.

Beyond diabetes and chronic kidney disease, other primary risk factors for AKI include older age, high blood pressure, and heart failure.

What are symptoms of acute kidney injury?

The signs acute kidney injury vary depending on the underlying cause, but common symptoms include:

  • Reduced urination
  • Blood in the urine
  • Swelling, especially around the feet and legs
  • Vomiting
  • Lack of appetite
  • Weakness
  • Fatigue
  • Shortness of breath

What are the main causes of acute kidney injury?

Acute kidney injury can be the result of reduced blood flow to the kidneys, damage to the kidneys, or a blockage that prevents urine from leaving the body. Some common causes of AKI include:

  • Diabetes: People with diabetes have a higher risk for developing AKI, particularly if they have additional conditions such as chronic kidney disease (especially if they have increased urine protein, measured by urine albumin to creatinine ratio) or heart disease, are taking medications that can cause AKI, or have had an AKI in the past.
  • Reduced kidney function in tests: Your kidney’s filtering ability and its overall function is measured through an estimated glomerular filtration rate (eGFR) test that measures the amount of creatinine (a waste product) in your blood in relation to your age, size, and gender.
  • Medications: Medications cause about 20% of AKI cases. Some medicines associated with AKIs include antibiotics, diuretics, and non-steroidal anti-inflammatories such as ibuprofen or naproxen.
  • Low blood pressure: When blood pressure falls too low, there is less blood available for organs, including the kidneys, increasing the risk of AKI. Common causes of low blood pressure include dehydration, heart failure, and certain medications.
  • Contrast dye: The dye used for some imaging studies may reduce blood flow to the kidneys. This can lead to AKI in people with certain underlying health conditions, especially diabetes.

How is AKI diagnosed and treated?

Acute kidney injury is diagnosed based on a physical exam and laboratory tests of kidney function including blood and urine tests such as the UACR and eGFR tests mentioned above. Additional testing may be required to determine the underlying cause of the condition. If left untreated, AKI can potentially lead to the need for dialysis or kidney transplant.

Fortunately, AKI may be reversible with proper and timely treatment. 

Because a disruption in kidney function can lead to the buildup of waste products and electrolyte imbalances, treatment may include fluids, balancing electrolytes, and stopping any medications that might be causing the condition. 

Most people improve their kidney function after treatment for AKI, but length of recovery time may vary from person to person. For some people, acute kidney injury will require dialysis. This may mean dialysis treatment in a hospital, at a dialysis center, or under the care of a nephrologist, or kidney specialist. The length of dialysis will likely depend on how long it takes for your kidneys to recover function.

Remember that it’s important to continue to receive follow-up medical care even after your kidney function has improved to ensure ongoing kidney health, especially since a history of AKI can increase your risk for future health problems such as chronic kidney disease, stroke, heart attack, and additional AKIs. 

How can people with diabetes prevent AKI?

Stay hydrated

Rosas encourages everyone with diabetes to reduce their risk of AKIs by staying hydrated. This includes remembering to drink more fluids on hot days or if you have a fever.  

Be proactive with testing

Regularly monitoring kidney function through annual blood (eGFR), urine (UACR), or imaging tests is also important, and ensures that healthcare professionals can prescribe the appropriate dose of your medications.

Avoid diuretic medications and contrast dyes if possible

“You should stop diuretics when you are sick with symptoms like vomiting, diarrhea, or fever,” Rosas said. She added that if you need to get medical imaging for any reason, you should “discuss with your doctor if it really requires IV contrast or if another test such as MRI may be a better option for you.”

Acute kidney injury and diabetes: The bottom line

While people living with diabetes are more likely to have acute kidney injury, keeping your kidneys healthy and knowing the risk factors, understanding the causes, and recognizing the symptoms could help you minimize your risk of AKI or treat its onset properly in a timely way. 

Learn more about taking care of your kidneys: