Download Acute Kidney Injury – Primary Care Guidance V1.0

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
