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NephrologyManagement

Acute Kidney Injury (AKI) Management (KDIGO)

Acute Kidney Injury (AKI) Management (KDIGO): Suspected Acute Kidney Injury → Apply KDIGO AKI Criteria → AKI Not Present.

Pathway Overview

14 steps

Algorithm Steps

14 total

  1. 01Start

    Suspected Acute Kidney Injury

    Patient with rising creatinine or decreased urine output

  2. 02Decision

    Apply KDIGO AKI Criteria

    Does patient meet AKI definition?

    • SCr increase ≥0.3 mg/dL within 48h, OR
    • SCr increase ≥1.5× baseline within 7 days, OR
    • Urine output <0.5 mL/kg/h for 6 hours
  3. 03Outcome

    AKI Not Present

    Monitor if at risk, reassess if clinical change

  4. 04Action

    Stage AKI Severity

    Determine AKI stage based on KDIGO criteria

    • Stage 1: SCr 1.5-1.9× baseline OR ≥0.3 mg/dL increase OR UO <0.5 mL/kg/h ×6-12h
    • Stage 2: SCr 2.0-2.9× baseline OR UO <0.5 mL/kg/h ×≥12h
    • Stage 3: SCr ≥3× baseline OR SCr ≥4.0 mg/dL OR UO <0.3 mL/kg/h ×≥24h OR Anuria ×12h OR Need for RRT
  5. 05Action

    Identify Etiology

    Determine pre-renal, intrinsic, or post-renal cause

    • Pre-renal: Hypovolemia, hypotension, heart failure, sepsis
    • Intrinsic: ATN, AIN, glomerulonephritis, vascular
    • Post-renal: Obstruction (BPH, stones, malignancy)
    • Check: FENa, urine sediment, renal ultrasound
  6. 06Decision

    Obstruction Present?

    Renal ultrasound shows hydronephrosis?

  7. 07Action

    Relieve Obstruction

    Urgent urological intervention

    • Foley catheter for bladder outlet obstruction
    • Urology consult for ureteric obstruction
    • Nephrostomy if needed
  8. 08Action

    Supportive Management

    Optimize hemodynamics and avoid nephrotoxins

    • Volume resuscitation if hypovolemic (crystalloid preferred)
    • Target MAP ≥65 mmHg
    • Stop nephrotoxins (NSAIDs, aminoglycosides, contrast)
    • Adjust drug dosing for renal function
    • Avoid hyperglycemia
  9. 09Action

    Monitor & Reassess

    Serial assessment of kidney function

    • Daily creatinine monitoring
    • Strict fluid balance
    • Monitor for complications (hyperkalemia, acidosis, volume overload)
    • Reassess etiology if not improving
  10. 10Decision

    Urgent RRT Indications?

    Life-threatening complications despite medical therapy?

    • Refractory hyperkalemia (K+ >6.5 with ECG changes)
    • Severe metabolic acidosis (pH <7.1)
    • Refractory pulmonary edema
    • Uremic complications (encephalopathy, pericarditis)
  11. 11Warning

    Initiate RRT

    Urgent renal replacement therapy indicated

    • CRRT preferred in hemodynamically unstable
    • Intermittent HD if stable
    • Nephrology consultation required
  12. 12Outcome

    Nephrology Follow-up

    All Stage 3 AKI or RRT require nephrology referral

  13. 13Action

    Continue Supportive Care

    Await renal recovery with ongoing management

  14. 14Outcome

    Renal Recovery

    Monitor for CKD development post-AKI

  15. Path rejoins step 08Shared downstream outcome

Guideline Source

KDIGO Clinical Practice Guideline for Acute Kidney Injury

DOI: 10.1159/000339789View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Does not address pediatric-specific AKI thresholds
  • Simplified for common presentations - complex patients require nephrology input
  • Does not cover dialysis modality selection in detail
  • Baseline creatinine estimation may be inaccurate in some populations

Contraindicated Populations

neonates

Applicable Regions

EUUSglobal

global: KDIGO criteria are internationally accepted standard for AKI diagnosis

Version 1Next review: 2027-01-01

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Risk Assessment

Glomerulonephritis Evaluation (KDIGO 2021)

Diagnostic

Hepatorenal Syndrome (HRS-AKI) Management (EASL)

Management

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eGFR (CKD-EPI 2021)

Estimated glomerular filtration rate using CKD-EPI 2021 equation (race-free)

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Frequently Asked Questions

What is the Acute Kidney Injury (AKI) Management (KDIGO)?

The Acute Kidney Injury (AKI) Management (KDIGO) is a management clinical algorithm for Nephrology. It provides a structured decision tree to guide clinical decision-making, based on KDIGO Clinical Practice Guideline for Acute Kidney Injury.

What guideline is the Acute Kidney Injury (AKI) Management (KDIGO) based on?

This algorithm is based on KDIGO Clinical Practice Guideline for Acute Kidney Injury (DOI: 10.1159/000339789).

What are the limitations of the Acute Kidney Injury (AKI) Management (KDIGO)?

Known limitations include: Does not address pediatric-specific AKI thresholds; Simplified for common presentations - complex patients require nephrology input; Does not cover dialysis modality selection in detail; Baseline creatinine estimation may be inaccurate in some populations. Individual patient factors may require deviation from these recommendations.

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