Acute Kidney Injury (AKI) Guideline

Patient in acute hospital setting Any Acute illness Oliguria / Anuria

 

Initial assessment : MEWS Urgent blood test: U &Es

Follow NICE clinical guideline 50

(Pulse, BP, Respiratory Rate, Temperature, Urine Output)

New abnormal renal function or if any change from available previous results - Acute Kidney Injury (AKI)

Confirmed AKI
. Urine dip test and microscopy Fluid balance i.e. intake/output monitoring and management Stop any nephrotoxic drugs (example- NSAID). Stop ACE Inhibitors and A2 receptor blockers. Avoid gentamicin / contrast Withhold anti-hypertensive if low BP (continue Beta blocker if
angina)

Consider urinary catheter Urgent renal ultrasound scan Daily U &Es till stable

Review by senior team member

AKI stage 1

AKI stage 2

AKI stage 3

-Treat underlying problems

(dehydration, sepsis etc.) -Daily U & Es -If no improvement: consider renal review*

- Treat underlying problems

(dehydration, sepsis etc.) - Consider renal screen - Consider renal referral * or discuss with on call renal registrar **

- Treat underlying problems (dehydration, sepsis etc.) - Urgent renal screen - Discuss with on call renal Registrar at RLUH** by telephone

*Renal referral: Fax -0151 706 5439 or ICE referral: 9am 5 pm / Weekdays ** On call renal SpR at RLUH to bleep through switch board (RLUH): 24 hours

M S Ahmed/ RLUH/ October 2009

Acute Kidney Injury (AKI) Guideline

Classification/staging system for acute kidney injury Stage Serum creatinine criteria Urine output criteria

Increase in serum creatinine of more than or equal to 26.4 mol/l or increase to more than or equal to 150% to 200% (1.5- to 2-fold) from baseline or, Increase in serum creatinine to more than 200% to 300% (> 2- to 3-fold) from baseline

Less than 0.5 ml/kg per hour for more than 6 hours Less than 0.5 ml/kg per hour for more than 12 hours Less than 0.3 ml/kg per hour for 24 hours or anuria for 12 hours

or,

Increase in serum creatinine to more than 300% (> 3fold) from baseline (or serum creatinine 354 mol/l with an acute increase of at least 44 mol/l]) or,

Mehta et al. Critical Care 2007 11:R31 doi:10.1186/cc5713

AKI classification based on either serum creatinine or urine output criteria MEWS Modified Early Warning Score. NICE Clinical Guideline 50: http://guidance.nice.org.uk/CG50/QuickRefGuide/pdf/English Renal screen: ANCA, Ds DNA, Anti GBM Ab, Serum Immunoglobulin & paraprotein,, urine BZP.

M S Ahmed/ RLUH/ October 2009