What steps should be taken to prevent AKI?
3Ms – Monitor, Maintain and Minimise
The following steps should be undertaken to prevent AKI in high-risk groups / scenarios:
1. Monitor
BCYP should have their creatinine checked and repeated if there are any concerns. Their fluid balance including urine output, weight, urinalysis and Paediatric Early Warning Score (PEWS) should also be recorded and reviewed on a daily basis. Any signs of sepsis should be urgently investigated and treated.
2. Maintain
Attention should be paid to ensure BCYP have an adequate circulatory volume and perfusion pressure. Hypo-perfusion should be addressed urgently with fluid boluses and inotropic support once the BCYP is volume replete. For further detailed guidance on fluid therapy please refer to the NICE guidance: Intravenous fluid therapy in children and young people in hospital (NG29).
3. Minimise
Further harm should be reduced by reviewing, adjusting and monitoring medication that may adversely affect renal function, including directly nephrotoxic drugs (e.g. NSAIDs, aminoglycosides, calcineurin inhibitors) and drugs that alter renal haemodynamics (e.g. ACEI, ARB, NSAIDs). Intravenous contrast should be used judiciously, weighing the risks and benefits for the individual patient.
See “BAPN AKI Management Recommendations” for full details.