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?
- you know how to deal with pulmonary oedema
- 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