Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + KIDNEY INJURY, ACUTE Download Section PDF Listen +++ +++ 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 ++ Inconsistent evidence for N-acetylcysteine use to prevent contrast-induced nephropathy.