Nice | Acute kidney unjury

This is a new guideline on Acute Kidney Injury. Acute Kidney Injury is the new name for Acute Renal Failure (ARF), although it has a much broader definition than ARF did. It is present in up to 18% of people admitted to hospital and is more prevalent in the elderly.

We are being encouraged to look for it a lot more carefully in the at risk populations if they are acutely unwell:

  • CKD
  • Heart failure
  • Liver disease
  • Diabetes
  • History of acute kidney injury
  • Oliguria (urine output less than 0.5 ml/kg/hour)
  • Any limitation of access to fluids (eg reliance on carer, neurological condition or child)
  • Hypovolaemia or Hypotension
  • Nephrotoxic drugs (eg NSAIDs, diuretics, ACEi, ARBs, aminoglycosides)
  • Use of iodinated contrast agents within the past week
  • Urinary obstruction, or higher risk of obstruction.
  • Sepsis
  • Age over 65
  • Any multi-system disease that could effect the kidneys (eg appearing with a purpuric rash)
  • New onset, or worsening urological symptoms.Severe Diarrhoea (in children)
  • Nephritis (in children)
  • Haematological Malignancy (in children)

The following criteria would suggest an acute kidney injury

  • Creatinine rise of
    • 26 micromol/litre or greater within 48 hours
    • 50% or greater rise within the past 7 days
  • Urine output < 0.5 ml/kg/hr for 6 hrs in adults or 8 hrs in children
  • eGFR fall of 25% or more in children and young people within the past 7 days

I guess the message here is to think about whether someone could be at risk and have a lower threshold for doing UE than we probably do now - even in the primary care scenario.

 

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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