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Acute Kidney Injury – Primary Care Guidance V1.0 Patient Name ………………………………………………………………………… University Hospitals of Morecambe Bay NHS Trust and Cumbria and North DOB………………………….…………….. Date…………………………………… Lancashire CCG AKI electronic alert (Diagnostic Criteria) Initial Management AED Immediate transfer if AKI &: Monitoring in the community Urgent referral Medical Registrar on call or Nephrologist Mobile 07415 229709 Follow up AKI 1 > 1.5x baseline or >26 µmol/l within 48h ABCDE – IT ( See bundle below) 24/48h U+E, HCO₃ Not resolving within 48h Patient leaflet Vasculitis AKI 2 >2.0x baseline AKI 3 > 3.0 baseline or > 354 µmol/l with acute increase Kᶧ>6.0mmol/l HCO₃ <17 Unwell Fluid overload Oliguria Obstructed Sepsis Monitor hydration (consider daily weight if risk of fluid overload) Sick day medication card U&E 2-3/ 52 Above + consider renal screen* if appropriate Urgent referral Medical Registrar on call, Tel: 01539 732288 Nephrology OPD if Concerned renal Specific pathology Nephrology OPD ABCDE-IT AKI Bundle Acute complications: High K>6.0, acidosis, fluid overload, oliguria refer to AED / BP Check fluid balance: Address dehydration, daily weights if evidence of overload Drugs: Stop nephrotoxins: ACEi/ARB2/Diuretics/Metformin/NSAID’s/Trimethoprim Exclude obstruction: Palpable bladder/ bladder scan/ (USS KUB) shows obstruction refer to AED : Systolic BP <110 increase oral fluids, hold BP meds/ diuretics. Systolic BP<100, unwell or pyrexial refer to AED Investigations: Urine dipstick, repeat U&E’s & HCO3 – within 48h, Consider renal screen* if haematuria, vasculitis, ?myeloma. (*ANA, ANCA, anti GBM ab, serum immunoglobulins & paraproteins, Urine BJP ) Treat cause: …………………………………………………….. Acute nephritis Dr Begho Obale Dec 2015, adapted from the NHS South Sefton CCG by permission of authors Dr Peter Chamberlain and Thangavelu Chandrasekar