Patient with Stage 1 or 2 Acute
Kidney Injury
Complications of AKI?
Yes
Management of AKI
Complications
(Click on each for further information):
- Hyperkalaemia (>6mmol/L)
- Acidosis
- Pulmonary Oedema
- Reduced Conscious Level
- Reduced Drug Clearance
Consider Critical Care Review
(Bleep 703)
No
Follow Below
Investigation of AKI
- Investigate the cause of all AKI unless
multi-organ failure or obvious precipitant
- Request ‘Renal Panel’ on CyberLab
- Urine dipstick. If proteinuria is present
perform urgent spot urine protein
creatinine ratio (UPCR).
- USS should be performed within 24
hours unless AKI cause is obvious or AKI
is recovering. USS within 6 hours if
obstruction is suspected.
- Check liver function (hepatorenal),
Venous Bicarbonate, CRP and CK
(rhabdomyolysis). If platelets low do blood
film/LDH/Bili/retics (HUS/TTP). If myeloma
is suspected send a serum for
electrophoresis (EPH) & Free Light
Chains (SLCH).
- If parenchymal kidney disease
suspected check renal antibody screen
If Urinary Tract
Obstruction on
USS refer to
Urology
If suspected Renal
Parenchymal
disease discuss
with Renal Unit
Fluid therapy in AKI
- Assess heart rate,
blood pressure, jugular
venous pressure,
capillary refill (should be
<3 secs), conscious
level.
- If hypovolaemic give
bolus fluids (e.g. 250-
500mls) until volume
replete with 1 hourly
review of response.
- Middle grade review if
>2 litres Have been given
and still oliguric.
- If the patient is
euvolaemic give
maintenance fluids
(estimated output plus 500mls).
Monitoring in AKI
- Take arterial blood gas and
lactate if venous bicarbonate is
low or evidence of severe
sepsis or hypoperfusion.
Follow Sepsis Pathway
- Consider insertion of urinary
catheter and measurement of
hourly urine volumes.
- Measure urea, creatinine,
electrolytes and venous
bicarbonate at least daily while
creatinine rising.
- Measure daily weights, keep
a fluid chart and perform a
minimum of 4 hourly
observations.
- Perform 4 hourly fluid
assessments and check for
signs of uraemia.
Contact Critical Care
Outreach Team/Acute
Response Team (ART) (Bleep
600) and parent team
AKI Stage 1
Serum creatinine:
Increase of serum
creatinine ≥ 26 μmol/L OR
increase from baseline of
150-200%
Urine Output: <0.5ml/kg/
hr for 6 hours
- Consider Urine Catheter
- 2 hourly urine output (if
catheterised)
- 2 hourly observations
- Repeat ABG, Creatinine
and Electrolytes at 24
hours (sooner if patients
condition worsens)
AKI Stage 2
Serum creatinine: Increase of
serum creatinine from baseline of
200-300%
Urine Output: <0.5ml/kg/hr for 12
hours
- Urine Catheter
- Hourly urine output
- Hourly observations
- Repeat ABG, Creatinine and
electrolytes at 12 hours (sooner if
patients condition worsens)
Senior review at < 6 hours
AKI Stage 3
Serum creatinine: Increase of
serum creatinine > 400 μmol/L OR
increase of >300% from baseline
Urine Output: <0.3ml/kg/hr for 12
hours OR anuric > 6 hrs
- Urine Catheter
- Hourly urine output
- Hourly observations
- Repeat ABG, Creatinine and
electrolytes at 8 hours (sooner if
patients condition worsens)
- Senior review < 3 hours
Inform Critical Care/Renal Unit
of patient
Supportive AKI Care
- Treat sepsis - in severe
sepsis intravenous
antibiotics should be
administered within 1 hour of
recognition.
Follow Sepsis Pathway
Follow Sepsis Pathway
- Stop NSAID/ACE/ARB/
metformin/K-sparing
diuretics and review all drug
dosages.
- Give proton pump inhibitor
and perform dietetic
assessment.
- Stop anti-hypertensives if
relative hypotension. If
hypovolaemic consider
stopping diuretics.
- Review other medications
for risk of accumulation in
renal impairment.
- Avoid radiological contrast
if possible. If given follow
prophylaxis protocol.