Acute Kidney Injury (AKI) is defined as an abrupt decline in renal function over 48 hours, identified by an increase in serum creatinine or a decrease in urine output. AKI is associated with high mortality rates ranging from 10-80%, depending on severity. Risk factors include older age, comorbidities, sepsis, hypotension, surgery, and certain medications. Preventing AKI requires identifying at-risk patients, improving fluid management, reducing medication risks, and recognizing deterioration early through monitoring and urinalysis. Timely treatment of underlying causes like sepsis, obstruction, or dehydration is key to responding to AKI.

1. Acute Kidney
Injury (AKI)

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WHAT IS ACUTE KIDNEY INJURY(AKI) ?
An abrupt decline in renal function defined by:
• An increase in serum creatinine > 26.5 umol/l within 48hours or
> 1.9 times baseline known or presumed in the last 7 days
OR
• A decrease in urine output to < 0.5ml / kg / hour for
6 hours or < 300mls in 12 hours

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What is an adequate urine output?
160 kg/ 80 mls /hr.
60kg/ 30mls/ hr.
0.5ml per kg per hour looks different
for different people

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Morbidity and mortality from AKI
• AKI is associated with high mortality and adverse long-term
outcomes and its prevalence in inpatients is believed to be
rising. The NCEPOD report indicates that AKI risk factors are
often not addressed and that a significant proportion of cases
may be avoidable (NCEPOD 2009).
• Mortality ranges from 10 – 80%
Renal Association (8th March 2011)

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More than 20% of
patients with an AKI
will die rising to > 35%
in those with AKI stage
3 (Think Kidneys)
Uncomplicated AKI has
a 10% mortality rate

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Patient Risk factors for AKI AKI Risk Events
• Over 75
• Have co-morbities such as
• Diabetes
• Heart failure
• Liver disease
• Peripheral vascular disease
• Chronic kidney disease
• Cognitive impairment
• Sepsis
• High risk medications
• Hypotension
• Hypovolaemia
• Major surgery
• Contrast scans
Always treat underlying cause of the AKI

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Signs and symptoms of AKI
• Evidence of dehydration
• Reduced urine output
• Changes to urine colour
• Nausea and vomiting
• Thirst
• Confusion or drowsiness

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What can we do to:
prevent, recognise and respond to an AKI
Prevent
Identify people at high risk of AKI
Improved management of fluid prescription and fluid balance
Reduce risk from medications
Recognise
IT solutions – algorithm and e-alerts
Early recognition of deteriorating patients

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Respond – Sepsis, hypovolaemia, obstruction, urinalysis, toxins
S O U T
Screen for
sepsis or
underlying
cause.
Assess and
document
fluid status
Bladder scan
and/or
ultrasound
H
Ensure
urinalysis
performed
Stop/change
high risk
medications

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High Risk Medications
Be aware of medicines that
may be harmful for your
patient and may make
them feel worse when they
are already unwell
• ACE inhibitors e.g. Ramipril
• Angiotensin receptor blockers e.g.
Losartan
• Metformin
• NSAID’s
• Diuretics
• Gentamicin/Vancomycin

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Why urinalysis?
• Simple , non-invasive easy to perform
• Early signs of kidney damage can cause protein and small
amounts of blood to be leaked into your urine
The earlier we spot and treat AKI the
more chance we have of it not progressing

12. Healthy wee is 1 – 3
4 – 8 you MUST hydrate


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Importance of fluid balance
• Monitor fluid balance on a daily and cumulative basis
• Daily weights are also a good indicator of acute fluid loss or gain
• Accurately record fluid input and output

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Summary
• Accurate recording of intake and output
• Urinalysis – urine colour
• Discontinuing and / or avoiding certain potentially high risk
medicines
• Monitor NEWS and escalate as indicated for unwell patients
Prevention, early identification and early
management are key to preventing an AKI, reducing
mortality and length of stay and improving our
patient outcomes

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NHS Tayside AKI video resource
https://www.youtube.com/watch?v=gW0pgXrIdgo

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References
• Adding insult to injury (2009) National confidential enquiry into
patient outcome & death. http://www.ncepod.org.uk/2009aki.htm
• www.renal.org/guidelines
• www.thinkkidneys.nhs.uk/aki