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Acute kidney injury in urological conditions Cover

Acute kidney injury in urological conditions

Asian Biomedicine
Volume 20 (2026): Issue 1 (February 2026)
By: ,  ,   and    
Open Access
|Feb 2026
Figures & tables

Figures & Tables

Figure 1.

Factors that affect SCr concentrations. SCr, serum creatinine.

Figure 2.

Differential diagnoses of AKI in urological conditions. ADT, androgen deprivation therapy; AKI, acute kidney injury; ESWL; extracorporeal shockwave lithotripsy; NSAIDs, non-steroidal anti-inflammatory drugs; PCNL, percutaneous nephrolithotomy; RIRS, retrograde intrarenal surgery; TRT, testosterone replacement therapy; URS, ureteroscopy.

Figure 3.

Functional changes during obstruction. Ang II, angiotensin II; ANP, atrial natriuretic peptide; GFR, glomerular filtration rate; NO, nitric oxide; PGE2, prostaglandin E2; Ptubule, tubular hydrolic pressure; Rafferent, afferent arteriolar resistance; RBF, renal blood flow; Refferent, efferent arteriolar resistance; RTA, renal tubular acidosis; TNF-α, tumour necrosis factor α; TXA2, thromboxane A2.

Figure 4.

Pathophysiology of obstructive nephropathy. Ang II, angiotensin II; ANP, atrial natriuretic peptide; GFR, glomerular filtration rate; Na, sodium; RBF, renal blood flow; RTA, renal tubular acidosis; TNF-α, tumor necrosis factor α; TGF-β, transforming growth factor β; TXA2, thromboxane A2.

KDIGO criteria for kidney disease

General concept
DefinitionDuration
NKDGFR > 60 mL/min/1.73 m2-
AKI AKI stage 1:

  • SCr rise 1.5–1.9 times from baseline in 7 d

  • OR SCr rise by ≥0.3 mg/dL (26.5 μmol/L) in <48 h

  • AND/OR urine output <0.5 mL/kg/h for 6–12 h

AKI stage 2:

  • SCr rise 2–2.9 times from baseline in 7 d

  • AND/OR urine output <0.5 mL/kg/h for >12 h

AKI stage 3:

  • SCr rise >3.0 times baseline

  • OR SCr increase to ≥4.0 mg/dL (>353.6 μmol/L)

  • OR decrease in eGFR to <35 mL/min/1.73 m2 in patients <18 years

  • OR urine output <0.3 mL/kg/h for ≥24 h

  • OR anuria for >12 h

  • OR initiation of RRT independent of SCr

<7 d
AKD

  • Presence of AKI

  • OR eGFR <60 mL/min/1.73 m2 or

  • OR decrease in eGFR by ≥35%

  • OR SCr rise by 50%

  • AND/OR structural markers of kidney damage

0–90 d
CKD

  • eGFR <60 mL/min/1.73 m2

  • AND/OR structural markers of kidney damage

>90 d

Anatomic locations and etiologies of urinary tract obstruction

Anatomic locations and etiologies of urinary tract obstruction
Kidney pelvis
  • –

    Kidney stones

Papillary necrosis
Ureter
  • –

    Bilateral obstruction (patients with CKD, unilateral obstruction with a solitary kidney)

Kidney stones, cancer, RPF, severe benign prostatic hypertrophy, neurogenic bladder, stenosis, abscess, ureteral valves, stricture, urinary retention, blood clots, tissues
Posterior to bladder Benign prostatic hypertrophy, cancer, clots
Extrinsic to urinary system
  • –

    Abdominal and pelvic malignancies, aortic aneurysm, pelvic fractures, atrophic vaginitis, vulvovaginitis, pelvic organ prolapse

  • –

    RPF

  • –

    Phimosis

Prostate hypertrophy/cancer

Risk factors for AKI during urological procedures

Pre-operativeIntra-operativePost-operative

  • Age

  • Smoking

  • Low baseline eGFR

  • Proteinuria

  • Solitary kidney

  • High BMI

  • Receipt of ACEI

  • Hypertension

  • Diabetes

  • Higher uric acid levels

  • Anemia

  • R.E.N.A.L. score (nephrectomy)

  • PADUA score (nephrectomy)

  • Tumour size

  • ASA score

  • Preoperative obstructive uropathy

  • Neoadjuvant chemotherapy

  • Bilateral PCNL

  • Longer operation time

  • Larger stone volume Intraoperative bleeding Multiple procedural tracts

  • Induced pneumoperitoneum during LPN

  • Intraoperative hypotension

  • WIT

  • Open nephrectomy (compared with LPN and RAPN)

  • High estimated kidney volume loss (>5.5 cm)

  • Console time

  • Retropubic RP (compared with RALRP)

  • Radical cystectomy with nephroureterectomy

  • Clamping time

  • Fluid balance

  • ERAS protocol

  • Postoperative ureteric obstruction

  • Postoperative urinary tract infection

  • Bleeding

  • Nephrotoxic agents

DOI: https://doi.org/10.2478/abm-2026-0002 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
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Language: English
Page range: 3 - 20
Published on: Feb 27, 2026
Published by: Chulalongkorn University
In partnership with: Paradigm Publishing Services
Publication frequency: 6 issues per year
Keywords:
acute kidney injury,
obstruction,
obstructive nephropathy,
urology
Related subjects:
Medicine,
Assistive professions, nursing,
Basic medical science,
Basic medical science, other,
Clinical medicine,
Clinical medicine, other

© 2026 Kittisak Weerapolchai, Nuttha Lumlertgul, Nattachai Srisawat, Marlies Ostermann, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 20 (2026): Issue 1 (February 2026)
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