AKI Management

Prevention is key:

  • early recognition of patient deterioration ie treat hypovolaemia/ hypotension

  • early recognition and escalation of reduced urine output – if urine output < 0.5ml/kg for two consecutive hours it should be investigated

  • Sepsis associated AKI is common, therefore it is important to identify and treat sepsis promptly to reduce the risk of AKI.

  • prevention of contrast induced nephropathy

    • ensure adequate hydration

    • consider stopping nephrotoxic drugs for 48 hours in at-risk groups

If AKI is diagnosed:

1. Correct hypovolaemia if present:

  • Crystalloid fluid bolus 500mls and re-assess. Repeat as necessary

  • give 250mls if suspicion of cardiogenic shock and monitor closely

2. Treat underlying pathology i.e. sepsis, haemorrhagic shock.

3. Stop any nephrotoxic medication if safe to do so.

  • Seek advice from senior medical team, renal team or pharmacist

4. Change urinary catheter if blockage suspected

5. Consider catheterisation for hourly urine output monitoring. Hourly fluid balance monitoring

6. Perform urine dipstick testing for blood, protein, leucocytes, nitrates and glucose

7. Diuretics are not advised except in the management of fluid overload

8. Consider renal ultrasound to look for intrinsic or obstructive pathology

9. Monitor renal function, electrolytes, pH and bicarbonate daily

10. Referral to renal team and ICU outreach team

  • Patient may require renal replacement therapy +/- vasopressors

Stop and think!

  • Is the patient better or worse?

  • Do we need any more help?