Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KIDNEY INJURY, ACUTE +++ Population ++ – Adults and children. +++ Recommendations +++ NICE 2019, VA/DoD 2019, KDIGO 2012 ++ – General care of the acutely ill patient. 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. – Adults receiving intravenous iodinated contrast Consider IV volume expansion to at-risk adults, including those with: CKD with eGFR <30 mL/min. Heart failure. Age 75 y or older. History of Renal transplant. Use of a large volume of contrast medium. Intra-arterial administration of contrast medium with first-pass renal exposure. Consider temporarily stopping ACE inhibitors and ARBs in adults having iodine-based contrast media if they have chronic kidney disease with an eGFR less than 40 mL/min. Inconsistent evidence for N-acetylcysteine use to prevent contrast-induced nephropathy. – Consult a pharmacist to assist with drug dosing in adults or children at risk for AK. +++ 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); 2019. https://www.nice.org.uk/guidance/ng148 – VA/DoD. Clinical Practice Guideline for the Management of Chronic Kidney Disease in Primary Care. Washington (DC): Department of Veterans Affairs, Department of Defense; 2019. – Kidney Disease Improving Global Outcomes (KDIGO). KDIGO Clinical Practice Guideline for Acute Kidney Injury: Kidney International Supplements; March 2012;2(1). +++ Comments ++ Acute kidney injury (AKI) is defined as any of the following the increase in SCr by ≥0.3 mg/dL over 48 h, increase in SCr to ≥1.5 times baseline within the past 7 d or urine volume <0.5 mL/kg/h for 6 h. Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth