Acute Kidney Injury for the Interventional Radiologist: A Review

AKI is commonly seen among hospitalized patients, many of which the VIR is consulted to assess for a potential intervention. Rates are increased for critically ill patients and those with pre-existing CKD, advanced age, or significant comorbidities. Developing an AKI is associated with increased morbidity, mortality, and risk of progression to chronic kidney disease. Physiologically, renal function depends on the coordinated activity of nephrons, which regulate fluid balance, electrolyte homeostasis, and metabolic waste filtration. Disruption of renal perfusion, injury to the microscopic and macroscopic renal structures, or obstruction of urinary outflow can impair these processes and lead to AKI. Clinical evaluation includes a focused history and physical examination, laboratory testing, urine analysis, and imaging studies to determine the underlying cause and guide management. The VIR will frequently encounter patients at risk for or experiencing AKI. For informed discussion with patients and other providers, optimal procedural planning, and enhanced post-procedural care, understanding the distinction between contrast-associated AKI and contrast-induced AKI and possible preventative strategies is vital. Given the enormous negative clinical impact of AKI, the VIR plays an important role in its prevention, diagnosis, and management.