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

	Causes	Investigations	Interventions
Pre-renal	- redistribution of fluid - ↓ renal blood flow: cardiac output	- urine output? - Other measures of fluid status e.g. IVC collapsibility etc.	Fluids treat underlying cause of shock (i.e. improve renal blood flow!)
Renal	- Acute tubular necrosis - Acute interstitial nephritis	- 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	- Upper tract obstruction - Ureteric obstruction - Bladder outlet obstruction	- USS KUB	Stents, nephrostomy → anything to relieve upward pressure

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

related topics

Haemolytic uraemic syndrome
Kidney stones
Renal replacement therapy

sources/links

https://derangedphysiology.com/main/required-reading/renal-intensive-care/Chapter-112/approach-assessment-oligoanuria
https://derangedphysiology.com/main/required-reading/renal-intensive-care/Chapter-111/causes-renal-failure

Sep 2026: edited to add ICU considerations