IDENTIFY
- Complete AKI Prevention tool at medical admission portals
Groups at higher risk
- Pre-existing chronic kidney disease
- Single kidney
- Previous episode of AKI
- Age >65 yr
- Neurological or cognitive impairment or disability
- possible limited access to fluids
- Sepsis
- Cardiac failure
- Atherosclerotic peripheral vascular disease
- Diabetes/cirrhosis/cancer
Causes
- Often multifactorial
- Pre-renal (perfusion)
- volume depletion
- hypotension, pump failure
- sepsis
- Renal (organ)
- established acute tubular necrosis – ischaemic or toxic
- glomerulonephritis/vasculitis
- tubulointerstitial nephritis
- Post-renal (obstructive)
MONITOR
- Fluid balance chart
- Start NEWS scoring to detect further deterioration at early point
- Adequate fluid replacement
- Write monitoring plan in notes and inform nursing staff
Stop/avoid potential nephrotoxins
- Gentamicin
- NSAIDs
- Minimise risk of acute kidney injury associated with radiographic contrast media
- see Prevention of contrast induced acute kidney injury guideline
- When prescribing diuretics/NSAIDs/ACE inhibitors/angiotensin-II receptor antagonists, inform patients about AKI risks
- give patient leaflet
Low BP
- Volume status assessment
- IV fluids
- Hold BP-lowering medication
- Consider vasopressors
Sepsis
Identify
- Suspected or confirmed infection
- qSOFA score >2
- RR >22 breaths/min
- Systolic BP <100 mmHg
- GCS ≤13
Response
- See Sepsis guideline
SURGERY
Risk factors in patients requiring surgery
- Emergency surgery, especially when associated with sepsis or hypovolaemia
- Intraperitoneal surgery
- Major joint surgery
- Assess baseline renal function in any at-risk group
Prevention
- Ensure adequate pre-operative hydration
- encourage patients who are nil-by-mouth for planned anaesthesia to drink clear fluids until 2 hr before anaesthesia
- If pre-operative U&E required in patient undergoing major surgical procedures, repeat 24 hr post-operatively
© 2022 The Bedside Clinical Guidelines Partnership.
Created by University Hospital North Midlands and Keele University School of Computing and Mathematics.
Research and development team: James Mitchell, Ed de Quincey, Charles Pantin, Naveed Mustfa