Acute kidney injury

N17.9

• Description
• General measures
• Medicine treatment
• Referral

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

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

Children

If fluid overloaded (rapid respiration, chest indrawing):

• Furosemide, IV, 1 mg/kg, over 5 minutes. See paediatric dosing tool.
  • 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, as an IV bolus, 80 mg.
  • Do not put up a drip and do not give a fluid infusion.

If hypertension present:

Diastolic BP > 100 mmHg or systolic BP > 150 mmHg:

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

AND

• Furosemide, oral, 40–80 mg as a pre-referral dose (if current eGFR unknown or < 30 mL/min).

LoEIII [2]

REFERRAL

All cases.