Acute Kidney Injury
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.
From Monday 6th November 2017 the Biochemistry departments in UHB, NBT and Weston will begin reporting 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
The Think Kidneys website also has useful Guides for Primary care on recognition and management of AKI in primary care and when to refer:
The website also has links to patient information including:
Consider immediate review and admission if AKI warning Stage 3 particularly in the context of acute illness.
Consider admission 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
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 bleep (9578) via Southmead switchboard
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.
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.
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