{"id":31,"date":"2018-04-13T18:13:10","date_gmt":"2018-04-13T18:13:10","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=31"},"modified":"2021-08-04T11:49:17","modified_gmt":"2021-08-04T11:49:17","slug":"aki","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/unithdbk\/aki-2\/aki\/","title":{"rendered":"AKI (for the generalist)"},"content":{"rendered":"\n<p>Describing recognition and early management of AKI. (More advanced info from <a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/aki-specialist\/\">Specialist page<\/a>).<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"color: #993300;\">Early Recognition (KDIGO criteria):<\/span><\/strong><\/h5>\n\n\n\n<p><strong><span style=\"color: #993300;\">AKI 1:<\/span><\/strong> creatinine rise from baseline of 1.5x or 26.5 micromol\/l, and\/or oliguria (urine output &lt;0.5ml\/kg\/hr for &gt;6hrs)<br>\n<strong><span style=\"color: #993300;\">AKI 2:<\/span><\/strong> rise of 2-3x baseline<br>\n<strong><span style=\"color: #993300;\">AKI 3:<\/span><\/strong> rise of &gt;3x baseline or &gt;354 micromol\/l, or need for RRT<\/p>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"color: #993300;\">Consider potential causes<\/span><\/strong><\/h5>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><a href=\"http:\/\/edren.org\/ren\/wp-content\/uploads\/2018\/10\/AKIsmUnitHbook.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"214\" src=\"http:\/\/edren.org\/ren\/wp-content\/uploads\/2018\/10\/AKIsmUnitHbook-300x214.jpg\" alt=\"\" class=\"wp-image-1734\" srcset=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2018\/10\/AKIsmUnitHbook-300x214.jpg 300w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2018\/10\/AKIsmUnitHbook-150x107.jpg 150w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2018\/10\/AKIsmUnitHbook.jpg 413w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>Sepsis<\/li><li>Hypoperfusion <ul><li>Cardiac\/liver failure<\/li><li>Haemorrhage<\/li><li>Dehydration <\/li><\/ul><\/li><li>Drugs or Contrast<\/li><li>Obstruction<\/li><li>Renal disease <ul><li>e.g rhabdomyolysis, glomerulonephritis, interstitial nephritis, myeloma<\/li><\/ul><\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"color: #993300;\">Assessment\/Management<\/span><\/strong><\/h5>\n\n\n\n<p><span style=\"color: #993300;\">1. Correct hypovolaemia<\/span>\n<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Use small fluid boluses (250ml) of crystalloid initially (see fluid therapy)<\/li><li>Regularly reassess JVP, peripheral perfusion, BP, urine output<\/li><\/ul>\n\n\n\n<p><span style=\"color: #993300;\">2. Address hypotension<\/span>\n<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>If persistent once euvolaemic, consider CVP monitoring +\/- vasopressors (HDU\/ ITU?)<\/li><\/ul>\n\n\n\n<p><span style=\"color: #993300;\">3. Manage hyperkalaemia<\/span>\n<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Hyperkalaemia protocol<\/li><\/ul>\n\n\n\n<p><span style=\"color: #993300;\">4. Review drugs<\/span>\n<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Stop any drugs which may contribute<\/li><li>Stop antihypertensives if BP low<\/li><li>Review all drug dosages in renal impairment<\/li><\/ul>\n\n\n\n<p><span style=\"color: #993300;\">5. Urinary tract ultrasound<\/span>\n<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Consider if clinical suspicion of obstruction\/abnormal renal tract<\/li><\/ul>\n\n\n\n<p><span style=\"color: #993300;\">6. ALERT SENIOR STAFF EARLY<\/span><\/p>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h5 class=\"wp-block-heading\">Required actions<\/h5>\n\n\n\n<p> 1. Senior review<br> 2. Updated renal function<br> 3. Check historic renal function<br> 4. Fluid balance assessment<br> 5. Drug chart review<br> 6. Urine dip (+\/- protein:creatinine ratio)<br> 7. Check acid\/base (TCO2 \/H+\/pH)<br> 8. Consider urinary tract ultrasound<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"color: #993300;\">Consider specialist (nephrology) referral if:<\/span><\/strong><\/h5>\n\n\n\n<ul class=\"wp-block-list\"><li>  Clinical suspicion of intrinsic renal disease (even if mild AKI) <ul><li>Proteinuria +\/- haematuria  <\/li><li>Absence of clear precipitant of AKI<\/li><li>Symptoms\/signs suggestive of systemic disease<\/li><li>e.g. rash, arthropathy, pulmonary infiltrates<\/li><\/ul><\/li><li>Progressive renal impairment<\/li><li>Renal transplant<\/li><li>Refractory pulmonary oedema<\/li><li>Refractory hyperkalaemia (&gt; 6.5 mmol\/L)<\/li><li>(Refractory acidosis (H+&gt; 60 nmol\/L; pH&lt;7.2))<\/li><li>(Background CKD 4\/5)<\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"color: #993300;\">AKI outcomes<\/span><\/strong><\/h5>\n\n\n\n<p>AKI is a smoke alarm! It is associated with:\n<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Longer hospital stay<\/li><li>Increased mortality<\/li><\/ul>\n\n\n\n<p><em>But most patients don&#8217;t die of renal failure.<\/em> They die from their underlying condition.<br>\nAnd remember that too much fluid is a bad prognostic feature in AKI.<\/p>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"color: #993300;\">Further info<\/span><\/strong><\/h5>\n\n\n\n<p><a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/fluid-therapy\/\">Fluid therapy<\/a> &#8211; our page on the principles and practice. <br><a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/aki-specialist\/\">AKI (specialist)<\/a>  &#8211; also has pointers to other sources of info, including for patients<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" width=\"980\" height=\"551\" src=\"https:\/\/www.youtube.com\/embed\/gW0pgXrIdgo?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p><span style=\"color: #808080; font-size: 12pt;\">Acknowledgements: Ailish Nimmo was the main author for this page, which was created in November 2017. Date last modified shown in footer.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Describing recognition and early management of AKI. (More advanced info from Specialist page). Early Recognition (KDIGO criteria): AKI 1: creatinine rise from baseline of 1.5x or 26.5 micromol\/l, and\/or oliguria (urine output &lt;0.5ml\/kg\/hr for &gt;6hrs) AKI 2: rise of 2-3x baseline AKI 3: rise of &gt;3x baseline or &gt;354 micromol\/l,\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/unithdbk\/aki-2\/aki\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5369,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-31","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/31","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=31"}],"version-history":[{"count":59,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/31\/revisions"}],"predecessor-version":[{"id":5529,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/31\/revisions\/5529"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/5369"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=31"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}