Acute kidney injury (Guidelines)

• Cr increase >1.5 to 1.9 x from baseline
• OR acute ↑ Cr >26micromol/L/48 hrs
• OR UO <0.5ml/kg/hr for >6 hours

• Cr increase >2 to 2.9 x from baseline
• OR UO <0.5ml/kg/hour >12 hours

• Cr increase >3 x from baseline
• OR Cr >354 micromol/L
• OR UO <0.3ml/kg/hr for 24hrs
• OR anuric for 12 hrs
• OR requires RRT irrespective of Cr

Clinical history

• risk factors
• accurate drug history

Examination

• SEWS
• volume status
• Glasgow Coma Scale (GCS)
• Respiratory status
• Palpable bladder
• Signs of sepsis
• Signs of vasculitis
• Urine output

Investigations

• serial U&Es
• HCO3, FBC, CRP, LFTs, calcium
• Urine PCR if proteinuria MSSU
• Chest X-ray
• ECG

Consider

• Renal USS
• Sepsis screen
• ABGs, lactate, CK amylase
• Vasculitic screen if haematuria & proteinuria
• Myeloma screen

As per Stage 1

AND 

• Renal US within 24 hrs
• Sepsis screen

As per Stage 2

AND 

• Look for multiorgan failure
• Chase Renal US

• Correct hypovolaemia
• Optimise blood pressure
• Accurate fluid balance
• Avoid nephrotoxins
• Rx sepsis
• Relieve obstruction
• Dose adjustment of renally excreted medication

Consider:

• Urinary catheter
• Senior review & CVP

As per Stage 1

AND

• Senior review
• Catheterise, 1° urine volumes  

Consider:

• CVP/cardiac monitoring
• Referral to Renal Team
• Dietician review
  Transfer to Level 2 care

As per Stage 2

AND

• Senior review
• Refer to Renal Team &
  transfer to Level 2 care
• Cardiac monitoring  

Consider:

• CVP insertion
• Referral to Intensive Care Unit (ICU)

See: Hyperkalaemia guideline