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:
- Heart failure
- Liver disease
- 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.
- 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.