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Primary Care Acute Kidney Injury (AKI) in adults

This guidance does not override the individual responsibility of health professionals to make appropriate decision according to the circumstances of the individual patient in consultation with the patient and /or carer.  Health care professionals must be prepared to justify any deviation from this guidance.

Primary care AKI image
Image Map

Pathway Information

Version 1
Review Date: 1st September 2017

If the boxes contain an i in the top left corner then there is more information available by clicking on the specific box.

The lists used in this pathway are not exhaustive and show the most common examples.

Purpose:

NHS England require that sudden changes in Creatinine are flagged as AKI to draw clinicians’ attention to that fact. The aim of this algorithm is to guide doctors working in primary care how to respond to an AKI alert in adults. The laboratory will indicate for an AKI alert whether this would be biochemically consistent with AKI stage 1, 2 or 3.

Disclaimer:

AKI is a syndrome with very heterogenous causes. For clarity this algorithm does NOT show a comprehensive list of causes but only shows the common and relevant ones. The same applies to the list of drugs relevant to AKI. You should also follow your own clinical judgment, if you wish to refer or ask for advice on a patient, even if not indicated by the algorithm.

Notes on basic tests in AKI:

Creatinine: Creatinine rises with a delay of hours to days after the causative renal insult. Therefore a repeat blood test should be sent as soon as possible, ideally within 24-48 hours. A rapid, major rise of Creatinine on repeat testing would suggest severe AKI likely requiring hospital treatment.

Hyperkalaemia: Hyperkalaemia is often spurious, particularly with blood samples travelling from primary care; the risk of spurious hyperkalaemia is reduced when blood samples get to the lab without delay (which is not always practical). True hyperkalaemia in acute kidney injury may be life-threatening and may be an indication for dialysis.  The potassium level of 6 mmol/L is a compromise between these two considerations.

Urinanalysis:

Major proteinuria (eg 3+ or 4+) suggests renal glomerular disease such as in nephrotic syndrome or vasculitis. Minor proteinuria (1+) may be seen in acute febrile / inflammatory conditions.

Haematuria may be a sign of renal glomerular disease or rhabdomyolysis, but also be caused by injury to the renal outflow tract including UTI.

Pyuria (leucocytes on dipstick) may occur in UTI but also renal inflammation such as interstitial nephritis or vasculitis.

Page last updated: 10 January 2018