Acute Kidney Injury Part 1:
Indications for urgent dialysis or haemofiltration:
The clinical state of the patient should be taken into account before commencing renal replacement therapy.
- Refractory and severe hyperkalaemia.
- Fluid overload with pulmonary oedema, refractory to diuretics.
- Severe metabolic acidosis.
- Renal replacement also indicated if urea and/or creatinine are significantly elevated.
Seek advice early!
- U&E (including total CO2), creatinine, glucose, FBC, clotting screen, group, screen and save, blood cultures.
- Plasma CK and urinary myoglobin (if available).
- Blood film for red cell fragments.
- Ca, PO4, LFTs, albumin.
- Glomerulonephritis screen where appropriate.
- Viral screen.
- Urine sodium and osmolality: interpretation is complicated by prior administration of IV fluids or diuretics.
- Urgent ultrasound of kidneys: size, number, obstruction, aorta. Ultrasound of the renal tract is mandatory in any patient presenting with AKI.