Acute kidney injury

It is well established that acute renal failure is associated with a significant increase in mortality, but over recent years it has become apparent that even relatively small rises in serum creatinine are associated with adverse patient outcomes. The term acute kidney injury (AKI) was developed to reflect this broader spectrum of renal injury, ranging from patients with small changes in blood chemistry to those with dialysis dependent renal failure. A universal definition and staging system for AKI has been proposed by the international guideline group Kidney Diseases: Improving Global Outcomes International (KDIGO). This will allow earlier recognition of patients with AKI and facilitate standardized clinical research. This article discusses a practical approach to managing a patient with AKI, with emphasis on optimizing physiological parameters and rapidly identifying patients who require specialist nephrology input.