In this section : Renal
Kidney Biopsy Complications
Parenteral Iron for Non-HD CKD Patients
Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s
Prescribing Advice on Admission – Insulin
Sodium Glucose Transporter 2 Inhibitors (SGLT2i)
Gentamicin in Renal Replacement Therapy
Vancomycin in Renal Replacement Therapy
Haemodialysis Medication Prescribing
Contrast Associated AKI
Acute Kidney Injury – Introduction
Low Molecular Weight Heparin
Fluid Replacement in AKI
Management of Urinary Symptoms
Management of Acute Kidney Injury
Urinary Tract Infection
Urethral Catheterisation
Renal Transplants
Ureteric Colic & Renal Stones
Intravascular Catheter Related Blood Stream Infection
Care of Vascular Access
Urinary Incontinence
Peritoneal Dialysis Related Peritonitis
Management of Acute Kidney Injury
Last updated 3rd December 2020
Last updated on 6th August 2013 by Calum Murray
Immediate Assessment
- Initial bloods may include LFTs, gases and clotting screen but not myeloma and vasculitis screen unless clinically indicated
- Consider urinary catheter (though may not be necessary)
- Always check urinalysis for blood and protein
- Blood culture if looks unwell
- Consider urgent ultrasound if cause of AKI not obvious
Treat Reversible Factors
- Rehydrate if dry – up to 6 or 7 litres if necessary, Click to View Section on Fluid Volume Status & Replacement in AKI
- Treat infections – sepsis can be both cause and complication of AKI
- Stop/avoid nephrotoxic drugs esp NSAIDs, ACEI and ARB
Consider Specific Therapies
- No specific treatment for ATN other than restoring renal perfusion
- Relief of obstruction if obstructed
- Steroids for interstitial nephritis
- Cyclophosphamide and steroid +/- PE for systemic vasculitis
- Plasma exchange with FFP for adult HUS/TTP
Organ Support
- Around 50% of patients developing AKI in Dumfries have single organ failure and 50% multi organ failure (MOF)
- The 2 other organs most likely to fail in AKI are lung and circulation
- Patients with MOF will usually require dialysis, ventilation and inotropic support
Indications for Dialysis
- Hyperkalaemia – especially if K+ >7 mmol/l in oliguric patient
- Pulmonary oedema – patients with AKI and pulmonary oedema do not generally respond to IV Frusemide
- Severe acidosis – especially if serum bic <10mmol/l and hypotensive
- Uraemia – BU >30mmol/l in a sick patient
- Pericarditis – a clear indication to start dialysis
Treat Complications
- Hyperkalemia – Click to View Section on Hyperkalaemia
- Acute pulmonary oedema (APO) – likely to require for dialysis as patients with AKI and APO do not respond to IV frusemide
Assess Bleeding Risk
- Platelet dysfunction in AKI increases risk of bleeding
- Rx half recommended dose of LMWH for prevention and treatment of DVT, treatment of ACS
Nutritional Support
- Patients with AKI lose their appetite while AKI itself is catabolic
- May require supplements – refer to renal dietitian
Review Drug Therapy
- Some drugs will be nephrotoxic eg aminoglycosides and others eg opiates will accumulate in AKI
- Stop K supp and K sparing diuretics in most cases