Clinical Scenario
AKI staging & KDIGO bundle
DEFINITION (KDIGO)
- Stage 1: creatinine ×1.5–1.9 baseline or ↑26 micromol/L in 48 h or UO <0.5 mL/kg/h × 6 h. - Stage 2: creatinine ×2.0–2.9 or UO <0.5 × 12 h. - Stage 3: creatinine ×3.0 or ≥354 micromol/L, or RRT, or UO <0.3 × 24 h or anuria 12 h.
CAUSES
- Pre-renal (60%): hypovolaemia, sepsis, HF, hepatorenal, NSAIDs. - Renal (30%): ATN, glomerulonephritis, AIN, vasculitis, rhabdomyolysis. - Post-renal (10%): stones, prostate, malignancy.
BUNDLE
- Stop nephrotoxins (ACEi/ARB, NSAID, diuretics, gentamicin), review contrast use, optimise volume status (fluid challenge if hypovolaemic), correct hyperkalaemia/acidosis, treat sepsis.
- USS KUB within 24 h to exclude obstruction.
- Urinalysis ± renal screen if intrinsic suspected.
INDICATIONS FOR RRT (AEIOU)
Acidosis (pH <7.15), Electrolyte (refractory K), Intoxication, Overload (refractory), Uraemia (encephalopathy, pericarditis, bleeding).