Assessing risk of acute kidney injury (AKI)

Assessing risk of acute kidney injury (AKI)

• in most patients AKI results from transient renal hypoperfusion or ischemia (1)
  • consequences include tubular cell dysfunction/damage, inflammation of the organ, and post-ischemic microvasculopathy. The two latter events perpetuate kidney damage in AKI
    
    
• identifying acute kidney injury in people with acute illness
  • NICE suggest to
    • investigate for acute kidney injury, by measuring serum creatinine and comparing with baseline, in adults with acute illness if any of the following are likely or present:
      • chronic kidney disease (adults with an estimated glomerular filtration rate [eGFR] less than 60 ml/min/1.73m2 are at particular risk)
      • heart failure
      • liver disease
      • diabetes
      • history of acute kidney injury
      • oliguria (urine output less than 0.5 ml/kg/hour)
      • neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer
      • hypovolaemia
      • use of drugs that can cause or exacerbate kidney injury (such as non-steroidal anti-inflammatory drugs [NSAIDs], aminoglycosides, angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor antagonists [ARBs] and diuretics) within the past week, especially if hypovolaemic
      • use of iodine-based contrast media within the past week
      • symptoms or history of urological obstruction, or conditions that may lead to obstruction
      • sepsis
      • deteriorating early warning scores
      • age 65 years or over
        
        
    • investigate for acute kidney injury, by measuring serum creatinine and comparing with baseline, in children and young people with acute illness if any of the following are likely or present:
      • chronic kidney disease
      • heart failure
      • liver disease
      • history of acute kidney injury
      • oliguria (urine output less than 0.5 ml/kg/hour)
      • young age, neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a parent or carer
      • hypovolaemia
      • use of drugs that can cause or exacerbate kidney injury (such as NSAIDs, aminoglycosides, ACE inhibitors, ARBs and diuretics) within the past week, especially if hypovolaemic
      • symptoms or history of urological obstruction, or conditions that may lead to obstruction
      • sepsis
      • a deteriorating paediatric early warning score
      • severe diarrhoea (children and young people with bloody diarrhoea are at particular risk)
      • symptoms or signs of nephritis (such as oedema or haematuria)
      • haematological malignancy
      • hypotension

Reference:

• Patschan D, Muller GA. Acute kidney injury. J Inj Violence Res. 2015 Jan;7(1):19-26.
• NICE (September 2023). Acute kidney injury - Prevention, detection and management of acute kidney injury up to the point of renal replacement therapy