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Acute Kidney Injury

Checked: 12-01-2023 by Rob Adams Next Review: 12-07-2023

Summary

In the UK up to 100 000 deaths a year are associated with acute kidney injury. Up to 30% could be prevented with the right care and treatment. The NHS Think Kidneys AKI Program has been successful in raising awareness and driving improvements in management of this important condition.

The Biochemistry departments in UHB, NBT and Weston will report Acute Kidney Injury (AKI) warning stage results to primary care. Previously these results were available in ICE but not sent directly to GP systems. This development is part of a national programme to improve outcomes for patients with AKI by more reliably identifying them.

The renal physicians are available at North Bristol Trust and they have a web page for clinicians which has contact details and advice.

Principles of Management

Local Pathway

See the BNSSG AKI Pathway

National Guidelines

The Think Kidneys website also has useful Guides for Primary care on recognition and management of AKI in primary care and when to refer:

Recognising and responding to AKI for adults in primary care

Quick guide to potentially problematic drugs and actions to take in primary care

When to restart drugs after an episode of AKI

Patient Information

The website also has links to patient information including:

Leaflet for patients at risk of AKI

Leaflet for patients who have had AKI

Red Flags

Consider immediate review and medical admission to local hospital if AKI warning Stage 3 particularly in the context of acute illness.

Consider medical admission to local hospital if K+ is 6.5 or above.

AKI risk factors that should prompt earlier review include:

Poor oral intake/urine output
Evidence of hyperkalaemia, especially if moderate(K+ 6.0-6.4) or severe (K+ ≥ 6.5 - see above)
Known history of CKD stages 4 & 5 or history of kidney transplant
Deficient Immunity
Frail with co-morbidities (CKD, diabetes, heart failure, liver disease, neurological or cognitive impairment)
Past history of AKI
Suspected intrinsic kidney disease
Suspected urinary tract obstruction

Rapid access advice is also available from the SpR (or consultant if registrar unavailable) via Southmead switchboard (01179 505050)

Follow up

Coding

GPs should code an episode of AKI in the medical record. If a patient has an episode of AKI during a hospital stay then this is now highlighted on discharge summaries and should be coded appropriately.

Medication Review

Following identification of an episode of AKI it is recommended that a medication review should be undertaken within a month to ensure that any necessary medications are restarted where indicated or discontinued if indicated. At this review patients should also be advised about the use of OTC medication.

Guides to stopping and restarting drugs can be found in the primary care section of the Think Kidneys website.

Investigations and Monitoring

Not all patients will experience a return to full renal function after an episode of AKI. It is recommended that patients are reviewed after 3 months to determine resolution, new onset or worsening of pre-existing CKD. Patients should therefore have a follow up creatinine, eGFR, urine ACR and a blood pressure reading within 3 months of diagnosis.

Refer to CKD guidelines (Clinical Knowledge Summaries) to support management in primary care and get advice on when to refer.

Patient Information

Informing patients that they have had an episode of AKI and giving written information can help to minimise the risk of a future episode. Other information for patients is available on the Think Kidneys website

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.