AKI
https://cks.nice.org.uk/topics/acute-kidney-injury/ [NICE REF guideline]
Definition:
AKI is the rapid decline (hours to days) of kidney function.
Causes:
The causes of acute kidney injury can be divided into
pre-renal (for example hypovolaemia, decreased cardiac output),
intrinsic renal (for example nephrotoxic drugs, interstitial nephritis),
and post-renal (for example renal stones, bladder outflow obstruction from prostate
enlargement).
Management:
address modifiable risk factors
Monitor serum creatinine after an episode of acute kidney injury. Base the frequency
of monitoring on the stability and degree of renal function at the time of discharge.
Stop nephrotoxic drugs
Treatment for perfusion failure:
Treat the underlying cause
Fluid volume replacement
Blood pressure support (inotropic drugs)
Restore arterial patency
Stop RAS blockage and stop NSAIDs
Only consider loop diuretic if:
Consider loop diuretics for treating fluid overload or oedema while:
an adult, child or young person is awaiting renal replacement therapy or
renal function is recovering in an adult, child or young person not receiving
renal replacement therapy.
Metformin cannot be given to those with a GFR<30 or AKI.
o It can trigger lactic acidosis which has a very high mortality of ~50%
o Insulin is usually prescribed instead
Diagnosis:
https://cks.nice.org.uk/topics/acute-kidney-injury/ [NICE REF guideline]
Definition:
AKI is the rapid decline (hours to days) of kidney function.
Causes:
The causes of acute kidney injury can be divided into
pre-renal (for example hypovolaemia, decreased cardiac output),
intrinsic renal (for example nephrotoxic drugs, interstitial nephritis),
and post-renal (for example renal stones, bladder outflow obstruction from prostate
enlargement).
Management:
address modifiable risk factors
Monitor serum creatinine after an episode of acute kidney injury. Base the frequency
of monitoring on the stability and degree of renal function at the time of discharge.
Stop nephrotoxic drugs
Treatment for perfusion failure:
Treat the underlying cause
Fluid volume replacement
Blood pressure support (inotropic drugs)
Restore arterial patency
Stop RAS blockage and stop NSAIDs
Only consider loop diuretic if:
Consider loop diuretics for treating fluid overload or oedema while:
an adult, child or young person is awaiting renal replacement therapy or
renal function is recovering in an adult, child or young person not receiving
renal replacement therapy.
Metformin cannot be given to those with a GFR<30 or AKI.
o It can trigger lactic acidosis which has a very high mortality of ~50%
o Insulin is usually prescribed instead
Diagnosis:
