Acute kidney injury

definition - KDIGO

Any of the following:

  • Increase in serum creatinine by ≥26 micromol/L (≥0.3 mg/dL) within 48 hours; or
  • Increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
  • Urine volume <0.5 mL/kg/hour for 6 hours.

general

resuscitation

  • dry or wet?
  • early referral to appropriate specialty
    • single organ → renal?
    • AKI as part of multi-organ failure → underlying cause? ICU?
    • kidney transplant → renal definitely

prescribing considerations

Stop nephrotoxics

  • NSAIDs
  • ACE inhibitors
  • aminoglycosides, vancomycin
    Renal dosing
  • insulin, opioids, digoxin

specific investigations

Investigations Interventions
Pre-renal - urine output?
- Other measures of fluid status e.g. IVC collapsibility etc.
Fluids
Renal - urine dip - proteinuria, haematuria
- we love bloods that we will never interpret in the context of sepsis!!!
- see glomerulonephritis and nephrotic syndrome
Steroids?
Post-renal - USS KUB Stents, nephrostomy → anything to relieve upward pressure

And regardless of this, there is sometimes the need for Renal replacement therapy