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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

  1. 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.

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