How should AKI be managed to prevent further damage?
Once AKI has developed the 3Ms – Monitor, Maintain and Minimise, should be undertaken to prevent further harm.
To establish the cause of AKI, a consultant should assess the BCYP urgently. In the majority of cases AKI will be pre-renal due to hypovolaemia and will be corrected with adequate fluid repletion. Further investigations allow identification of established intra-renal disease and obstruction. Early detection and referral of BCYP with intra-renal disease such as nephritis, vasculitis and haemolytic uraemic syndrome may help ameliorate the course of the disease and reduce the risk of progression to CKD.
The following investigations are recommended for all BCYP with AKI:
- Full blood count, creatinine, electrolytes, bone profile, bicarbonate
- Urinalysis, urine microscopy
- Urinary tract ultrasound
Further Management (including referral guidance):
| Stage | Investigations | Discussion |
| AKI 1 | If clinically relevant – C3/C4, ASOT, immunoglobulins, ANA, ANCA, anti-GBM antibodies, CK, LDH, blood film. | Consider discussion with: a paediatrician with a specialist interest in nephrology (SPIN) or tertiary nephrologist particularly if known CKD/ patient with kidney transplant or if there are features of intrinsic renal disease e.g. nephritis or haemolytic uraemic syndrome. |
| AKI 2 | Investigations as for AKI 1. | Discuss with SPIN or tertiary nephrologist. |
| AKI 3 | Investigations as for AKI 1. | Discuss with tertiary nephrologist. |
See “BAPN AKI Management Recommendations” for list of indications for urgent referral to paediatric nephrologist and suggested follow-up.