New to Acute Kidney Injury? Start Here
Acute Kidney Injury: the few things that matter most, and the mistakes that catch people out early.
A sudden fall in kidney function over hours or days, usually triggered by another illness.
Key takeaways
- Usual triggers: dehydration, infection, and medicines taken through it
- Commonly implicated: NSAIDs, ACE inhibitors, ARBs, diuretics, metformin, SGLT2 inhibitors
- Most useful single change: Get written sick day rules if you take any of the implicated medicines.
- Commonest mistake: Continuing diuretics and ACE inhibitors while significantly dehydrated.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Why bother
It is common, frequently preventable, and most community cases involve dehydration plus ordinary medicines.
Start here
Two things, and nothing else until both feel routine.
- Get written sick day rules if you take any of the implicated medicines
- Keep fluids up during vomiting, diarrhoea or fever
Then add these
The next additions, when you are ready for them.
- Pause the relevant medicines when unwell and seek advice
- Restart medicines only when advised
The numbers, in one place
| Measure | Figure |
|---|---|
| Usual triggers | dehydration, infection, and medicines taken through it |
| Commonly implicated | NSAIDs, ACE inhibitors, ARBs, diuretics, metformin, SGLT2 inhibitors |
| Detection | a rising creatinine or falling urine output |
| Often reversible | if recognised and treated early |
Common early mistakes
- Continuing diuretics and ACE inhibitors while significantly dehydrated
- NSAIDs during any dehydrating illness
- Assuming reduced urine output during illness is normal
Where to go next
- Acute Kidney Injury: What the Evidence Actually Says
- Acute Kidney Injury, Explained Without the Jargon
- Acute Kidney Injury — the reference entry
- The Evidence on Chronic Kidney Disease, Without the Hype
- What the Guidance Really Says About Kidney Stones
When to speak to a doctor
Seek same-day medical help for passing much less urine than usual, swelling of the legs or face, breathlessness, nausea and vomiting, or confusion and drowsiness during an illness. Call 999 for severe breathlessness, chest pain, palpitations or collapse. Pause the medicines listed above and seek advice rather than waiting.
Where this comes from
- NICE — Acute kidney injury: prevention, detection and management
- Think Kidneys — AKI
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
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