Volume loss; ↑BUN/Cr
Calculators: crcl
Confirm: FENa <1%, BUN/Cr >20, ↑urine osm, bland sediment
Treat: IV isotonic fluids; stop nephrotoxins / NSAIDs / diuretics
Order set U&E, urinalysis FENa/urine indices Assess volume Fluid challenge Medication review FENa unreliable on diuretics → fractional excretion of urea (FEUrea <35%) Criteria Admit Significant AKI or complications
Dialysis AEIOU indications
Discharge Renal function recovering, euvolaemic, nephrotoxins stopped
Clinical detail — differentials, red flags, pitfalls, disposition Red flags Anuria Hyperkalaemia Fluid overload/uraemia Differentials ATN Obstruction Glomerulonephritis Common mistakes Fluids in a fluid-overloaded patient Continuing nephrotoxins Disposition & follow-up Restore perfusion; stop nephrotoxins; monitor U&E.
Discharge package Medications Review/withhold nephrotoxins; restart cautiously
Follow-up Recheck renal function; primary care
Lifestyle Hydration, sick-day medication rules
Warning symptoms Reduced urine, swelling, confusion
💊 Treatment detail — doses & preparation 0.9% Sodium chloride crystalloid
Dose Bolus 500 mL over 15–30 min, reassess; maintenance 1–1.5 mL/kg/h
Preparation 500/1000 mL bags; add KCl only after urine output confirmed
Monitor Hyperchloraemic acidosis with large volumes — prefer balanced (LR) for resuscitation
Hold nephrotoxics safety
Dose Stop ACEi/ARB/diuretics/NSAIDs/metformin during AKI ('sick-day rules')
Preparation —
Monitor Restart when euvolaemic and creatinine stable
📖 KDIGO 2012 AKI (2026 AKI/AKD update in press — recommendations consistent with draft) Reviewed July 2026