Which combination best describes common contributors to acute kidney injury in hospitalized patients?

• A. Hypervolemia, and overhydration.
• B. Overhydration alone.
• C. Hypovolemia, nephrotoxic medications, and sepsis.
• D. Chronic kidney disease only.

Answer: (C)

Acute kidney injury in hospitalized patients is most often driven by factors that reduce kidney perfusion, damage the renal tubules directly, or worsen systemic inflammation. Hypovolemia lowers effective circulating volume and renal blood flow, leading to prerenal AKI. Nephrotoxic medications—such as certain antibiotics, NSAIDs, contrast dyes, and some chemotherapy agents—can injure renal tubules or impair kidney function directly. Sepsis adds a further hit by causing widespread inflammation and hypotension, aggravating renal hypoperfusion and injury. So, the combination of hypovolemia, nephrotoxic medications, and sepsis captures the main, modifiable contributors seen in the hospital setting. Overhydration is less commonly a primary driver, and chronic kidney disease increases risk but does not by itself account for the acute events described.