This guideline discuss what increases the risk of AKI:

• Emergency surgery, ie, risk of sepsis or hypovolaemia
• Intraperitoneal surgery
• CKD, ie if eGFR < 60
• Diabetes
• Heart failure
• Age >65 years
• Liver disease
• Use of nephrotoxic drugs
  • NSAIDs
  • aminoglycosides
  • ACE inhibitors/angiotensin II receptor antagonists
  • diuretics

Diagnostic criteria

It also defines the criteria for diagnosing AKI

• Rise in creatinine of 26µmol/L or more in 48 hours OR

• = 50% rise in creatinine over 7 days OR

• Fall in urine output to < 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children) OR

• = 25% fall in eGFR in children / young adults in 7 days.

Staging criteria

The Kidney Disease: Improving Global Outcomes (KDIGO) criteria are widely used to stage the AKI:

| Stage 1 | Increase in creatinine to 1.5-1.9 times baseline, or Increase in creatinine by ≥26.5 µmol/L, or Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours | | --- | --- | | Stage 2 | Increase in creatinine to 2.0 to 2.9 times baseline, or Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours | | Stage 3 | Increase in creatinine to ≥ 3.0 times baseline, or Increase in creatinine to ≥353.6 µmol/L or Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or The initiation of kidney replacement therapy, or, In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2 |

Referral criteria

Refer to a nephrologist if any of the following apply: