24th June 2024

Management

Immediate management is supportive and guided by the cause.

Key points in the management are

• Regular assessment and optimisation of volume status
• Suspend nephrotoxic drugs and adjust doses of therapeutic drugs according to renal function
• Screen for infections and treat promptly if present
• Ensure adequate nutritional support
• Monitor urinary output and arrange urgent imaging tests if urinary tract obstruction is suspected
• Manage complications such as hyperkalaemia, pulmonary oedema, uraemic complications and acideamia

Refer the following life-threatening complications for emergency renal replacement therapy (RRT):

• Refractory hyperkalaemia (potassium >6.5 mmol/L)
• Refractory metabolic acidosis (pH <7.15)
• Refractory volume overload with or without pulmonary oedema
• End-organ complications of uraemia (e.g. pericarditis, encephalopathy, uraemic bleeding) or other end-organ involvement (e.g. neuropathy, myopathy)
• Severe AKI and poisoning/drug overdose (e.g. secondary to ethylene glycol, lithium).