AKI algorithm Flashcards
Step 1
You have an elevated creatinine
Compare it to the baseline, is it and AKI or CKD?
Serum creatinine elevated at baseline/did not meet KDIGO definition of AKI => CKD
Serum creatinine >1.5x baseline or
Greater than 26.5umol/l or
Greater than 0.3 mg/dL in 48hours
Go to Step 2
Step 2
Is there a post renal cause
Do a kidney USS, is there an obstruction?
Obstruction present => post renal cause
-catheterise, investigate and address this
No obstruction => Step3
Step 3
Does the history, examination, investigations, urinalysis support a presently or intrinsic cause?
Prerenal cause => give IV fluid challenge
-if responsive, provide supportive therapy
If unresponsive => intrinsic cause
Go to Step 4
Step 4, suspected intrinsic cause
Perform a urinalysis and blood tests
Review past procedures
ATN if
- ischemic
- nephrotoxic drugs (aminoglycosides, contrast, statins)
- myoglobin from rhabdomyolysis
- muddy brown casts, proteinuria
Glomerulonephritis if
- Antiglomerular basement membrane disease autoantibodies
- ANCA antibodies found (cANCA, pANCA)
- post infective
- immune complex GN (lupus)
- nephritic, nephrotic syndromes
- RBC casts, proteinuria, fatty casts (if nephrotic)
Interstitial nephritis
- drugs (NSAIDS, PPIs, penicillin)
- local infection
- systemic autoimmune disease (sjogrens, lupus)
- WBC casts
Vascular
-obstruction from thromboembolism