Acute kidney injury in primary care
Module created June 2014
Since 2007, the preferred term for acute changes in kidney function, of all severity, has been acute kidney injury (AKI) (1). Acute kidney injury is not a ‘new’ disease. This term embraces the spectrum of disease previously covered by acute tubular necrosis (ATN) and acute renal failure (ARF). However, this change is much more than just semantics, including, and thereby emphasising the importance of, even small changes in kidney function. These changes may not have immediate consequences in their own right, but they identify someone who is at risk of more significant changes in kidney function without appropriate management: they are a ‘Red Flag’. Early intervention prevents progression and restores normal kidney function in many cases. Furthermore, mortality increases with increasing stage of AKI (2), early intervention therefore improving outcomes significantly. Understanding of how to diagnose AKI and intervene early is thus central to improving outcomes in AKI.
Acute kidney injury is a disease process that is most often a complication of disease outside the kidneys and most often starts before the patient is admitted to hospital. Importantly, this widens the net of doctors to whom AKI is relevant, AKI no longer being the preserve of intensivists and nephrologists. AKI encompasses a broad spectrum of disease, initially manifest by small rises in creatinine presenting to primary care and non-renal secondary care physicians and surgeons. It has been suggested that up to 30% of AKI may be avoidable with recognition of the ‘at risk’ patient, early diagnosis and intervention (3, 4). The essential role of GPs in early detection and prevention of AKI is clear and has been emphasised recently (5).
Small changes in kidney function are a ‘Red Flag’ for patients at risk of significant changes in kidney function
This module has been written specifically for Primary Care workers but has information that would be useful for all clinical staff involved in the care of the acutely ill patient at risk.
Author - Dr. Richard Smith, Nephrologist