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Akut njurskada

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Sakkunnig:
Definition:
Plötslig – över timmar till dagar – försämring av njurarnas funktion.
Förekomst:
Under 2021 hade cirka 6 000 personer i Sverige diagnos akut njursvikt i sluten vård, motsvarande 58/100 000 invånare.
Symtom:
Minskad urinproduktion, eventuellt uremiska symtom (illamående, trötthet, medvetandepåverkan). Symtom från bakomliggande orsak – prerenal (exempelvis hypotoni, stor blödning, hjärtsvikt), renal (exempelvis nefrotoxiska ämnen, akut interstitiell nefrit, glomerulonefriter) eller postrenal (avflödeshinder).
Kliniska fynd:
Förändring i hydreringsgraden. Kliniska fynd talande för bakomliggande orsaker.
Diagnostik:
Blodstatus, elektrolyter, urea, kreatinin, fosfat, syra-bas-status, CRP. Eventuellt urinsediment, s- och u-osmolalitet, u-Na och u-kreatinin. Ultraljud urinblåsa, njurar och urinvägar. 
Behandling:
Behandla bakomliggande orsak och komplikationer som hyperkalemi, hyponatremi, acidos, hyperfosfatemi och lungödem. Dosjustera vissa läkemedel. Övervaka vätskeintag och urinproduktion. Kontrollera näringsintag. I svåra fall kan dialys bli aktuellt.
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  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet.
  • Terje Johannessen, professor i allmennmedisin, Trondheim.