ACUTE KIDNEY INJURY (AKI)-SUPPORTIVE MANAGEMENT
SUMMARY
1. For all patients. Complications to manage: fluid overload, hyperkalaemia, acidosis, uraemia.
VOLUME
2. Correct renal hypoperfusion: manage sepsis, hypotension, dehydration/intravascular volume depletion, drugs/nephrotoxins.
3. Prevention: pre-hydration for IV/IA contrast studies (and cessation of nephrotoxins).
4. Volume management: maintain euvolaemia (JVP +3cm, no/no change in peripheral oedema, chest clear, normotension, stable body weight), IDC not essential (portal of infection).
5. IV fluids to correct deficiency: cease if patient euvolaemic. Fluid restriction often required due to inadequate urine output (once euvolaemic). Avoid K+ in fluids in renal failure.
DIURETICS
6. Diuretics for fluid overload: use high dose IV frusemide (up to 250mg). If no response: no benefit in repeat dose. Can re-attempt on daily/2nd daily basis. Don't use small doses.
7. Can diuretics kick start a kidney? No, but they can delay dialysis by managing fluid overload, hyperkalemia & reducing acidosis. They do not impact upon uraemia.
ACIDOSIS
8. Acidosis: Na bicarbonate therapy (100ml 8.4%) vials may be necessary if HCO3- < 10. At this point there usually exists an indication for dialysis therapy.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
