DEFINITION OF AKI  (KDIGO)

  1. Increase in creatinine by 0.3 over 48-72 hours (must be prospective)   OR
  2. Increase in creatinine 1.5X baseline
    1. Baseline creatinine can be established from values up to one year previously. 
    2. b.If no previous creatinine level, use lowest creatinine level during hospitalization as baseline.

    Specify cause of AKI – prerenal, renal or postrenal

Consider ACUTE TUBULAR NECROSIS if:

1. Creatinine does not return to baseline after 48-72 hours on IV fluid.

2. Patient has been hypotensive.

3. Patient has sepsis or severe sepsis.

4. Patient has been on vanco, aminoglycosides, synthetic cannabinoids or radiocontrast media.

INPATIENT OR OBSERVATION?

  1. Most patients with AKI due to dehydration will start out OBS.   If creatinine is not improving with IV fluids or patient remains unable to take po, conversion to inpatient status is appropriate.
  2. Consider Inpatient status for:
    1. Increase in creatinine 3X baseline
    2. b.Creatinine over 4 with acute rise > 0.5
    3. Anuria in a well-hydrated patient
    4. d.Severe encephalopathy
    5. e.Hemodynamic instability
    6. Severe electrolyte abnormality or acidosis
    7. New to dialysis
    8. h.Severe hypertension (> 180/120)
    9. Pulmonary edema with hypoxia
  3. For patients with CKD, consider Inpatient status for:
    1. Severe encephalopathy
    2. b.Recurrent seizures
    3. Unexplained syncope
    4. d.Severe or persistent uremic symptoms
    5. e.Persistent hypoxia
    6. Need for urgent dialysis in someone new to dialysis or with non-useable vascular access.