Acute kidney injury is a sudden decline in kidney function that leads to impaired waste elimination, fluid imbalance, and electrolyte disturbances. It is a common and serious condition encountered in the ICU, often developing in the setting of sepsis, shock, major surgery, trauma, or exposure to nephrotoxic agents. AKI significantly increases the risk of mortality, prolonged ICU stay, and long-term kidney disease.

In critically ill patients, AKI often results from reduced blood flow to the kidneys, inflammatory injury, or direct toxic damage. Patients may present with reduced urine output, fluid overload, rising creatinine levels, electrolyte abnormalities, and metabolic acidosis. In severe cases, AKI can rapidly progress to life-threatening complications requiring urgent ICU intervention.

ICU management of AKI focuses on identifying and correcting the underlying cause while supporting kidney function. Maintaining adequate blood pressure and circulation is essential to preserve renal perfusion. Careful fluid management is critical, as both dehydration and fluid overload can worsen outcomes. Nephrotoxic medications are avoided whenever possible.

In patients with severe AKI, renal replacement therapy such as continuous dialysis may be required to manage fluid balance, electrolyte disturbances, and toxin removal. ICU teams closely monitor laboratory parameters and adjust therapy based on the patient’s evolving condition.

AKI rarely occurs in isolation and is often part of multi-organ dysfunction. ICU care therefore integrates kidney support with management of respiratory, cardiovascular, and metabolic complications. Early detection and timely intervention significantly improve recovery and reduce the risk of progression to chronic kidney disease.