1. Acute Kidney Injury (AKI)

2. 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

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

4. 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)

5. 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

6. 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

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

8. 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

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

10. 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
Certain medications can make our patients feel worse and it would be good if these could be avoided if possible
The health professional teams will take an accurate history on admission and with support from the pharmacy team, will review medication

11. 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 

13. 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

14. 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

15. NHS Tayside AKI video resource

16. References
Adding insult to injury (2009) National confidential enquiry into patient outcome & death.