Detect AKI by comparing creatinine with baseline. Most AKI is pre-renal or drug-related and reversible.
Act now
- 1
See Low urine output: catheter check, fluid challenge if hypovolaemic, stop nephrotoxins, treat sepsis.
Assess
- Stage by creatinine rise or urine output (KDIGO). Review fluid status, sepsis, obstruction, drugs, recent contrast.
- Urine dipstick for blood and protein (possible intrinsic renal disease).
Investigations
- U&E daily (more often if K⁺ high), venous gas, urine dip and ACR/PCR, FBC, CK if rhabdomyolysis possible.
- Ultrasound within 24 hours if cause unclear or obstruction risk; within 6 hours if pyonephrosis suspected.
Manage
- Hold ACE inhibitors/ARBs, diuretics, NSAIDs, metformin and other renally cleared drugs; renally adjust antibiotics and anticoagulants.
- Fluid balance and daily weights; avoid further contrast unless essential.
Escalate when
- Refractory hyperkalaemia, metabolic acidosis, fluid overload, uraemic complications, or suspected intrinsic renal disease: nephrology/critical care.
Written to current guidance (NICE NG148) · sources checked 14 Nov 2026. We watch NICE for updates weekly.
Sources (1)
Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026
Calculators for this
For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.