Acute kidney injury
EBM Guidelines
Oct 31, 2023 • Latest change Feb 10, 2025
Table of contents
Extract
- In acute kidney injury (AKI) the ability of the glomeruli to filtrate deteriorates, which leads to a disturbed acid-base and fluid balance as well as to the accumulation of end products of nitrogen metabolism.
- A common finding especially in hospital patients
- Within 24 to 48 hours of the onset of the injury the serum creatinine concentration will rise and urine output fall.
- AKI weakens the prognosis considerably and should be identified as early as possible (before the creatinine concentration is markedly increased and the estimated glomerular filtration rate [eGFR] falls).
- A typical patient is an older individual with pre-existing renal impairment who also contracts acute injury as a consequence of, for example, acute diarrhoea or the use of nephrotoxic drugs or drugs affecting blood circulation in glomeruli (e.g. NSAIDs, ACE inhibitors), i.e. acute-on-chronic kidney injury.
- Hypovolaemia is the most common cause of oliguria and can usually be reversed with fluid therapy. Changes in the fluid balance of a seriously ill patient must be monitored carefully.
- Urinary retention must be identified and treated.
- The prevention of AKI should be paid special attention in patients with chronic renal failure, diabetes or hypertension and the elderly.
- The concomitant use of an ACE inhibitor, diuretic and NSAID increases the risk – patient education is important.
Linked evidence summaries
- The use of NSAIDs appears to increase the risk of acute renal failure. The risk appears to be slightly higher in the elderly and those with chronic kidney disease.B
- Furosemide may not be effective in the prevention or treatment of acute renal kidney injury in adults.C
Search terms
AKI, Acute kidney injury, Anuria, Contrast Media, Creatinine, Dialysis, Diuresis, Embolism, Cholesterol, Filtration, Fluid Therapy, Furosemide, Hematuria, Hyperkalemia, Hypertension, Hypotension, Hypovolemia, Internal medicine, Kidney Failure, Kidney Failure, Acute, Kidney Failure, Chronic, Muscle Hypotonia, N17*, N19, N99.0, Nephritis, Nephritis, Interstitial, Nephrology, Oliguria, Proteinuria, Renal Dialysis, Renal Insufficiency, Rhabdomyolysis, Uremia, Urethral Obstruction, Urinary Retention, Urine, acute interstitial nephritis, contrast study, dark urine, metabolic acidosis, obstruction, postrenal anuria, x-ray contrast examination