Assess stage of AKI
- Stage 1 – Creatinine rise of 26μmol/L within 48 hours (or rise in baseline >1.5 times)
- Stage 2 – Creatinine rise > 2 times baseline
- Stage 3 – Creatinine rise of > 354 μmol/L (or rise in baseline > 3 times)
Assess the patient
- Medications
- ACEI/ARB
- Diuretics
- NSAIDs
- Metformin
- PPI
- Recent contrast
- Assess hydration
- Check BP
- Urine dipstick
- if infection – avoid trimethoprim/nitrofurantoin
- if blood/protein – consider intrinsic renal problem
- Exclude palpable bladder
- Consider risk factors – age > 65, CKD, previous AKI, falls with long lie, diabetes, vascular/heart/liver disease, malignancy
Management
- Stage 1 – repeat U+Es in 5-7 days
- Stage 2 – repeat U+Es in 48 hours + USS KUB
- Stage 3 – refer immediately to local renal team
Other reasons for immediate referral to local renal team
- New finding of blood++ or protein++ on dipstick (in absence of UTI, regardless of stage)
- Systemic symptoms – vasculitic rash, epistaxis, haemoptysis
- Kidney transplant
- AKI on CKD stage 4 or greater
- Inadequate response to initial treatment
- Obstruction suspected – refer to urology
Source: “KCH Adult Acute Kidney Injury Care Pathway for Primary Care ”