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Assessing risk of acute kidney injury (AKI)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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:


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