Acute Kidney Injury

Description

General Measures

Medicine Treatment 

Referral

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N17.9

DESCRIPTION

This is (potentially) reversible kidney failure, commonly as a result of:

• Hypovolaemia and fluid loss
• Medicines/ toxins
• Urinary tract obstruction
• Acute tubular necrosis
• Acute glomerulonephritis
• Sepsis

It is often recognised by:

• Fluid overload (e.g. pulmonary oedema),
• Decreased or no urine output,
• Abnormalities of serum urea, creatinine and/or electrolytes,
• Convulsions in children.

GENERAL MEASURES

• Give oxygen, and nurse in Semi-Fowlers position if patient has respiratory distress. Early referral is essential.
• If fluid overloaded:
  • Stop all IV fluids.
• If dehydrated or shocked:
  • Treat immediately as shock. See: Shock
• Stop and avoid any nephrotoxic medicines e.g. NSAIDs, aminoglycosides.

MEDICINE TREATMENT

• Review all prescribed medications regularly in the setting of kidney failure to ensure that they are safe and at the correct dose for the eGFR.
• Currently, the most reliable measure of eGFR is CKD-EPI in adults and Schwartz equation for children. Nephrotoxic drugs should be avoided in the setting of any kidney dysfunction. Prior to starting any medication review for previous drug allergies and adverse events. Monitoring of drug toxicity and levels is important where available (e.g. aminoglycoside).
• In acute kidney injury (AKI) the once-off eGFR is not reliable as kidney function changes rapidly. Therefore, it is essential to monitor eGFR and doses of medications regularly.

Children

If fluid overloaded (rapid respiration, chest indrawing):

• Furosemide, IV, 1 mg/kg, over 5 minutes. See: dosing table
  • Do not put up a drip or run in any IV fluids.

If hypertension present:

<6 years of age	>120 mmHg systolic BP OR  >90 mmHg diastolic BP
6–15 years	>130 mmHg systolic BP OR  >95 mmHg diastolic BP

• Nifedipine, oral, 0.25–0.5 mg/kg squirted into mouth.
  • Withdraw contents of 5 mg capsule with a 1 mL syringe:
  • 10-25 kg: 2.5 mg
  • 25-50 kg: 5 mg
  • >50 kg: 10 mg

Adults

If fluid overloaded/ respiratory distress:

• Furosemide, oral or IV, 20 to 80 mg daily, as a single or divided doses, initiating at the lowest effective dose and titrating upwards.
  • Dose may be increased to 160 mg, IV or oral, daily in divided doses.
  • First establish an effective dose and ascertain if urination occurs within 1-2 hours of intake. If urination does not occur, increase the dose further until urination occurs.

If blood pressure is elevated hypertension is present (Diastolic BP > 100 mmHg or systolic BP > 150 mmHg):

• Amlodipine, oral, 5 mg as a pre-referral dose.

If eGFR is currently unknown or < 30 ml/min, ADD:

• Furosemide, oral, 40–80 mg as a pre-referral dose.

LoE:IIIb⁵

REFERRAL

• All cases.

Click here to access the pdf

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_17 October 2024

Chapter 8: Kidney and Urological Disorders_8.2 Acute Kidney Injury (AKI)