Download Acute kidney injury (AKI)

Acute kidney injury (AKI)
Patient/carer information leaflet
You have been given this leaflet because you or the person you care for has been diagnosed
as having had an Acute Kidney Injury.
What is Acute kidney injury (AKI)?
Acute Kidney Injury or AKI is a sudden fall in kidney function as measured by blood tests and
urine output, AKI is identified in the same way. Although named Acute Kidney Injury it is only
very rare that the kidneys have been physically injured.
AKI used to be called 'acute renal failure' or 'acute kidney failure’. Up to one in five people
admitted to hospital in UK have AKI. AKI can get better in a few days or weeks, but
sometimes it can be life threatening. Early treatment is important.
AKI is not to be confused with Chronic Kidney Disease (CKD) which is used to describe
long-term kidney problems that occur either when the kidneys don’t work as well as normal.
AKI can lead to CKD or worsen CKD in those that already have it.
What causes AKI?
AKI in patients with cancer can be caused by a variety of individual factors or combination
of them. AKI can be caused by dehydration, illnesses or infections, major surgery, or from
the side-effect of drugs. AKI may also be caused when flow of urine from kidneys through
the ureters or bladder is blocked as in prostate and cervical cancer.
The elderly and patients with chronic kidney disease and diabetes-mellitus are particularly
at risk of AKI. Patients with heart or liver failure are also at higher risk. Patients receiving
platinum chemotherapy, contrast containing iodine and radiotherapy to head and neck are
at risk as well.
Where the kidneys are and what do they do?
The kidneys have a key role in determining our water balance, by adjusting the amount of
water we pass in the urine according to our levels of hydration.
Most people have two kidneys that lie on either side of the back bone just below the ribs. The
kidneys make urine which is passed out via the ureters (the tubes that connect the kidneys to
the bladder) and bladder allowing removal of waste products that may be harmful to the body.
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What are the symptoms of AKI?
You may not have any symptoms until your kidney function deteriorates significantly. AKI
can however have the following symptoms:
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Changes in urine output, particularly a reduction in the amount passed.
Nausea and vomiting.
Abdominal pains and feeling generally unwell.
Skin itching, muscle twitches, confusion and drowsiness.
How is AKI diagnosed?
Blood is tested for a substance, called creatinine, which is produced by body muscles and
is removed by the kidneys. If there is a reduction in kidney function the creatinine levels will
rise. AKI can also be diagnosed by measuring the volume of urine produced.
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What are the risks of AKI?
Although AKI can be mild, in more serious forms the loss of kidney function may cause:
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An increase in potassium in the blood affecting your heart.
Blood may become acidic damaging other organs.
Salt and water build-up leading to swelling of your legs, hands or face.
In some cases, fluid may build up in the lungs and affect breathing.
What is done in hospital for AKI?
Blood and urine tests, x-rays and ECGs will be used to identify the cause of your AKI. An
ultrasound scan of the kidneys may be performed in certain situations.
Once identified, treatment is directed at the underlying cause:
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Fluid balance is measured by measuring your fluid intake and your urine output and
you may need a small tube called a catheter inserting into your bladder.
We may stop some of your medications or adjust the dose.
If you are taking chemotherapy tablets we may need to temporarily withhold these.
You may need anti-sickness and anti-diarrhoea medication.
Your diet may be adjusted to slow down the build-up of toxins.
We may give you fluid may through a drip in a vein.
If we reduce or stop your medications whilst your kidneys are recovering, we will
review these before you are discharged and give you a plan of when to restart them if
appropriate.
What are the long-term effects of AKI?
AKI is usually treated successfully. You may need to be followed up by the hospital medical
team or your GP to monitor whether your kidney function returns to normal. If you become
unwell you should contact The Christie Hotline on 0161 446 3658 regarding following the
sick day rules outlined overleaf.
Whilst in hospital your doctor will keep you informed of your progress. Once discharged you
and your GP should receive information regarding your hospital stay including diagnosis of
AKI, medication review plan for any medications withheld and a plan for blood test monitoring.
A dietitian may see you if your doctor feels you need specific dietary advice.
In some patients kidney function does not fully recover after AKI. In a very small
minority of AKI patients there is significant damage to the kidneys and they may
need dialysis or, if suitable, kidney transplantation.
In some patients, oncologists may need to change or stop chemotherapy treatment.
This can have a consequence on further cancer management.
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How can I avoid AKI in the future?
You must follow the sick day rules overleaf when you are unwell with any of the following:
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Vomiting where you are unable to keep fluids down.
Nausea where you do not feel like eating or drinking.
Mucositis where you have a sore mouth or throat and unable to drink enough.
Diarrhoea where you lose more water in stools than you manage to drink.
Fevers or feverish illness.
Feeling light-headed or excessively thirsty.
Medicine sick day rules
1. Contact The Christie Hotline on 0161 446 3658 if you are unable to keep fluids down
and/or have continuing nausea, vomiting, difficulty swallowing or diarrhoea. Make sure
you have a list of your medication to hand, as we may advise you to stop taking any
medications which may cause AKI. If you are on oral anti-cancer treatment you might be
advised to hold it until your symptoms improve.
2. Drink plenty of fluid to make sure you have enough fluids in your body. This is likely to be
at least 7 cups a day (one cup = 200ml) unless you have other instructions from your
doctor. If you are vomiting, take small sips of water/fluid frequently until your symptoms
have settled.
3. Avoid drinking alcoholic drinks when you are unwell.
4. Inform your pharmacist regarding previous AKI when obtaining any medications including
those that do not require a prescription.
You may need a blood test to check for AKI.
If you are you under the care of a specialist team e.g. heart failure
team or kidney/renal unit or diabetes team.
If you are then contact the relevant team before following medication advice on the next
page and remember to mention any medication that has been started recently.
If not you should contact The Christie Hotline on 0161 446 3658 for advice before
temporarily stopping the medication listed on the next page until your symptoms settle.
If symptoms persist for more than 24 hours, please contact The Christie Hotline for
advice.
This is important.
Dehydration may harm your kidneys and certain tablets can make
this harm worse.
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Medications to be STOPPED during sick day rules
(See question on page 4 first)
Ace inhibitors: given for blood pressure and heart or kidney problems.
Examples include ramipril, lisinopril, perindopril and others ending with ‘pril’.
ARBs: given for blood pressure and heart or kidney problems
Examples: losartan, candesartan, irbesartan, valsartan and others ending with
“sartan”
NSAIDs: anti-inflammatory painkillers.
Examples: ibuprofen, naproxen, diclofenac, celecoxib, etoricoxib, meloxicam
among others
Diuretics: sometimes called water pills. Examples: furosemide, bumetanide,
spironolactone, eplerenone, bendroflumethiazide, indapamide.
Metformin or metformin combinations: medicine for diabetes
*This list is not exhaustive. If you are not sure whether your medicines
belong to these categories, or if you have branded medicines and you
are not sure of their other proper chemical (generic) name, please talk to
your doctor or pharmacist.
N.B. Ask your doctor if you are on Medications listed above?
If Yes, list here
Yes
No
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Other sources of information and support
There are a number of organisations that provide support and advice for people and their
families with acute kidney injury.
Think Kidneys Website
www.thinkkidneys.nhs.uk
Helpline 0845 601 02 09 (freephone UK Landlines)
The British Kidney Patient Association
www.britishkidney-pa.co.uk
Free counselling and support service available every Tuesday and Wednesday
The National Kidney Federation
www.kidney.org.uk/
Helpline 0845 601 02 09 (freephone UK Landlines)
Kidney Research UK
www.kidneyresearchuk.org/
Telephone 0845 070 7601
Kidney Dialysis Information Centre
www.kidneydialysis.org.uk/
Reproduced with kind permission of:
Cheshire & Mersey Strategic Clinical Networks AKI Leaflet
Think Kidney ‘Information for the public’
The Christie Patient Information Service May 2016
CHR/URO/1150/22.03.16 Version 1 Review May 2019
www.christie.nhs.uk Tel: 0161 446 3000
Details of the sources used are available, please contact [email protected]
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