Acute Kidney Injury — PrerenalUrgent

Three days of diarrhoea and vomiting on ramipril, furosemide and diclofenac; dizzy on standing; creatinine 2.8 mg/dL (baseline 1.0), urine output 20 mL/h

• Anuria (obstruction, vascular, cortical necrosis)
• K⁺ ≥6.5
• Pulmonary oedema
• Active urinary sediment (GN)

• ATN (sepsis, ischaemia, toxins)
• Obstruction
• Glomerulonephritis/vasculitis
• Acute interstitial nephritis (PPIs, NSAIDs, antibiotics)
• Hepatorenal syndrome

• Admit: Stage 2–3 AKI, K⁺ >6, overload, unable to drink, or cause needing inpatient care
• ICU: Hyperkalaemia with ECG changes, pulmonary oedema, shock
• Dialysis: Refractory K⁺, acidosis, overload, uraemic encephalopathy/pericarditis, dialysable toxin

• India: diarrhoeal illness, sepsis, NSAIDs, snakebite, malaria, leptospirosis and herbal remedies are common causes.
• Restart ACE inhibitor/ARB and SGLT2 inhibitor once stable for 48 h — they protect kidneys long-term.
• AKI survivors have higher CKD risk — recheck at 3 months (acute kidney disease follow-up).

• Give fluids to a patient who is already overloaded to "flush the kidneys"
• Continue NSAIDs, ACE inhibitor/ARB or metformin during AKI
• Start dialysis for a creatinine number alone
• Forget to recheck renal function after discharge

• Fluids to an overloaded patient
• Leaving nephrotoxins on
• FENa on diuretics (use FEUrea)
• No ultrasound

Ward with daily U&E; nephrology if not improving in 48 h, intrinsic cause suspected or RRT likely.