Prerenal Acute Kidney Injury (Prerenal AKI) is the most common form of acute kidney injury and occurs due to reduced blood flow to the kidneys without direct structural damage to renal tissue. It is frequently encountered in hospitalized patients across the UAE, particularly among the elderly, critically ill individuals, and those with chronic medical conditions such as heart failure, diabetes, and liver disease. When identified early, prerenal AKI is largely reversible; however, delayed intervention can result in permanent kidney damage.

The kidneys rely on adequate blood flow to maintain filtration and metabolic balance. In prerenal AKI, factors such as dehydration, blood loss, severe infection, hypotension, heart failure, or excessive use of diuretics lead to diminished renal perfusion. As blood flow decreases, the kidneys activate compensatory mechanisms to conserve sodium and water in an attempt to preserve circulation. If hypoperfusion persists, these protective mechanisms fail, and ischemic injury may develop.

Clinically, patients may present with reduced urine output, dizziness, low blood pressure, dry mucous membranes, and signs of volume depletion. In hospitalized settings, prerenal AKI may be detected incidentally through rising serum creatinine levels. Laboratory findings typically show concentrated urine, low urinary sodium, and an elevated blood urea nitrogen–to–creatinine ratio, reflecting the kidney’s attempt to conserve fluid.

Diagnosis is based on clinical context, physical examination, laboratory evaluation, and response to treatment. Blood tests assess kidney function and electrolyte balance, while urine analysis helps differentiate prerenal AKI from intrinsic renal injury. Imaging studies are generally normal but may be performed to exclude obstruction if clinical suspicion exists.

Management focuses on rapid restoration of renal perfusion. This includes intravenous fluid resuscitation, correction of blood loss, treatment of underlying infection, and optimization of cardiac function where applicable. Medications that impair renal blood flow are reviewed and adjusted. Close monitoring of urine output and kidney function is essential during recovery.

With prompt and appropriate intervention, kidney function often improves within days. However, untreated or prolonged prerenal AKI may progress to acute tubular necrosis, highlighting the importance of early nephrology involvement. Patients who experience recurrent episodes are at increased risk of developing chronic kidney disease and require long-term follow-up.