"improving intensive care in Scotland"

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.
  • Pericarditis
  • 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).
  • ABGs
  • Blood film for red cell fragments.
  • Ca, PO4, LFTs, albumin.
  • Urate
  • Glomerulonephritis screen where appropriate.
  • Viral screen.
  • Urinalysis
  • 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.

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