Chapter 20: Renal Disorders

KIDNEY INJURY, ACUTE

Population

• –Adults and children.

Recommendations

NICE 2013, VA/DoD 2014, KDIGO 2012

• –Acute kidney injury (AKI) is defined as the increase in the SCr by equal to or greater than 0.3 mg/dL over 48 h, or increase in SCr to equal to or greater than 1.5 times baseline within the past 7 d, or urine volume <0.5 mL/kg/h for 6 h.

• –Recommendations for acute management:

  • In the absence of hemorrhagic shock, use of isotonic crystalloids rather than colloids for intravascular volume expansion.

  • Do not use diuretics to prevent or treat AKI except in the management of volume overload.

  • Do not use low-dose dopamine in either the prevention or treatment of AKI.

  • Use vasopressors in addition to fluids for management of vasomotor shock with or at risk for AKI.

• –Recommend volume expansion to at-risk adults who will receive intravenous iodinated contrast.

  • CKD with eGFR <40 mL/min.

  • CHF.

  • Renal transplant.

  • 75 y or over.

• –Consult a pharmacist to assist with drug dosing in adults or children at risk for AKI.

Sources

• –NICE. Acute Kidney Injury: Prevention, Detection and Management of Acute Kidney Injury up to the Point of Renal Replacement Therapy. London (UK): National Institute for Health and Care Excellence (NICE); 2013.

• –VA/DoD. Clinical Practice Guideline for the Management of Chronic Kidney Disease in Primary Care. Washington (DC): Department of Veterans Affairs, Department of Defense; 2014.

• –Kidney Disease Improving Global Outcomes (KDIGO). KDIGO Clinical Practice Guideline for Acute Kidney Injury: Kidney International Supplements; March 2012;2(1).

Comment

1. Inconsistent evidence for N-acetylcysteine use to prevent contrast-induced nephropathy.