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Acute Kidney Injury

A patient leaflet for those with an acute kidney injury.

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Information for patients
This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request.

What is Acute Kidney Injury(AKI)?

Acute kidney injury (AKI) occurs when the kidneys aren’t working normally. The kidneys are organs in your tummy/abdomen towards the back, typically present on both sides of the body, and produce urine, which drains into the bladder and is then passed. The word ‘injury’ in this case does not mean that your kidneys have been physically wounded such as a physical blow to the kidneys, but rather that something has stopped them from working properly, an internal process such as dehydration or a blockage that stops you passing urine, for example constipation. If your kidneys stop working properly it can be dangerous or even life threatening.

What do my kidneys do normally?

The kidneys can do many things but mainly clean the blood by removing waste and help keep water, salts and hormones regulated.

This includes:

  • Clean your blood.
  • Get rid of waste products.
  • Keep the right amount of chemicals and salts in your blood, like sodium and potassium.
  • Help to keep the right amount of fluid in your body and help make urine.
  • Help make red blood cells (prevent you getting anaemic).
  • Help keep acid levels right in your body
  • Help with maintaining healthy bones and blood pressures.

What causes AKI?

AKI is common and normally happens as a complication of another serious illness. AKI is most common in people aged over 65. Other things that can increase your risk of AKI include:

  • Having Chronic Kidney Disease (CKD).
  • Autoimmune causes.
  • Having sepsis (infection of the blood).
  • Use of some recreational drugs.
  • Long term use of some medications such as non-steroidal anti-inflammatory (NSAIDS – such as ibuprofen or aspirin).
  • Other health conditions that can affect the kidneys, such as:

o        Diabetes.

o        Severe Pancreatitis.

o        Heart failure.

An AKI can occur if your body has too little or too much fluid – this is known as a “pre-renal” AKI. The problem is the kidneys not getting enough fluid through them. Being too dry may be a result of not drinking enough or having an illness such as diarrhoea and vomiting. Being too wet may be a result of an organ not working strongly enough, such as the kidneys, liver or heart. This can be fixed either by giving fluid, or by giving medicines to help pull fluid from the body through the kidney.

Another cause of AKI can be an obstructive problem, where the kidneys cannot drain urine properly. This may be from the bladder not being able to empty because of a blockage such as an enlarged prostate or constipation. It may also become too relaxed through several causes, such as when a person is poorly. A catheter and/or removing the blockage may be necessary to protect the kidneys and a Urologist may offer more interventions if needed.

The kidneys can get damaged directly. If this occurs over a period of time, this may lead to chronic kidney disease, which your GP may have been monitoring. If it occurs acutely, this may be because of medicines, infection, or the body reacting to itself. This may involve further investigations often investigated by Renal doctors (Nephrologists).

What are the symptoms of AKI?

Some patients have no signs or symptoms, and it is only detected on a blood test. Some patients might have symptoms such as:

  •         Urinating a lot less than usual.
  •        Swelling of the feet, legs and around the eyes.
  •         Feeling itchy.
  •         Extreme thirst.
  •         Dizziness.
  •         Attacks of shortness of breath and coughing during the night.
  •         Urine may change darker in colour.
  •         Shortness of breath when you lie down.
  •         Increased heart rate.
  •         Tiredness/drowsiness.
  •         Confusion.
  •         Loss of appetite/nausea and vomiting.

If you have any of these symptoms, seek medical help. Additionally, always get urgent medical help if you have trouble breathing or your heart beats in a way that it is not usual. On their own, they do not usually suggest anything serious.

What investigations do I need?

  •          Blood tests.
  •          Urine Samples.
  •         Ultrasound of kidneys, bladder and urinary tract.
  •          May require chest X-ray/CT scan/Biopsy.
  •          Weight measured to see if you are gaining or losing fluid over time.

How do we treat AKI?

It depends on the primary cause. Some patients will need:

  • Intravenous therapy (fluid drip) if you are dehydrated.
  • It is also possible to be over-hydrated when you have AKI. Therefore, you might need to take medication to make you urinate (pee) more (a diuretic).
  • You will be on a strict fluid balance chart where your fluid is measured involving fluid you drink or receive via a drip, and fluid you pass (this includes urine, vomit & faeces) you may be required to have a catheter or the nursing teams will provide you with bedpans and urine bottles.
  • Antibiotics if there is an infection.
  • A bladder catheter may be used to allow close monitoring of how much urine you are making. The catheter is passed through the urethra (the tube that carries urine from your kidneys out of your body).
  • If a blockage is found in either your kidneys or bladder, you may need to have either surgery or another procedure to remove it.
  • Your medications will be reviewed upon diagnosis of an AKI. Some may be temporarily stopped to allow your kidneys to recover, this will be discussed with you. Your medications will be reviewed and your GP will receive this information.

As the kidneys manage waste, salts and fluid in the body, these can increase and cause complications by building up in the body. These may reach dangerous levels and further treatments may be needed to keep the person safe.

If the kidneys are seriously affected, some patients may need to be admitted to Critical Care or the Renal ward to be offered a treatment called dialysis. This involves filtering the blood to remove waste materials in the hope your kidneys will recover; but it comes with risks and is not routinely offered.

If dialysis is needed you will require a special line inserted into your vein to allow the machine to be attached. There are a small number of patients whose kidneys will never recover from AKI and if this happens you will remain under the care of kidney specialists, you may need permanent dialysis and further treatment options will then be discussed.

When you are severely dehydrated because of AKI, it can reduce how much blood you have in your veins and arteries. This can cause your blood pressure to fall too low. Sometimes you may need to be given medication in critical care, to raise your blood pressure until your blood level is back to normal.

Some patients may require an admission to Critical Care as a result of AKI. Critical Care is where the most unwell patients in the hospital are treated. Critical Care includes both the Intensive Care Unit (ICU) and High Dependency Unit (HDU).

You may need drugs called corticosteroids (steroids) to help reduce swelling in your kidneys. (These are not the same as the anabolic steroids used by some bodybuilders and athletes).

Some people die from AKI, although the cause of death is often an underlying condition that caused the kidney problem, rather than AKI itself. Death is more likely in people whose AKI is more severe.

What about medications?

Sometimes medications taken for other reasons can affect the kidneys and cause AKI.

These include:

NSAIDs (non-steroidal anti-inflammatory drugs):

  • Ibuprofen
  • Naproxen
  • Diclofenac

    Blood pressure medication:
  • Lisinopril
  • Ramipril
  • Enalapril
  • Perindopril
  • Losartan
  • Candesartan
  • Valsartan

    Diuretics (water tablets)    :
  • Bendroflumethiazide
  • Furosemide
  • Spironolactone
  • Bumetanide

Many medicines can contribute to an AKI like the examples above. While these may worsen an AKI, it is often because they are making another problem worse, such as dehydration. These used to be called “nephrotoxic” medicines, however, this term is no longer appropriate as many are protective of the kidney when a person is not poorly. The healthcare team may temporarily stop these medicines while a person is poorly, but may reintroduce them over time once the body shows signs of recovery. This may be done after discharge with the support of community teams like a GP or Pharmacist.

You may also be given future “sick days rules/guidance” from your doctor or pharmacists. Sick day rule/guidance is an aid to help you understand which medicines you should stop taking temporarily during illness which can result in dehydration. Please always seek advice from a healthcare professional before stopping your medications.

What happens after I go home?

We will tell your GP that you have had AKI and the treatment you have been provided, as well as any follow-up care you may need.  Your GP may want to recheck your blood tests or see you soon after you are discharged to review your medications and advise you on next steps. Most patient’s kidneys will get better and make a full kidney recovery. If this happens, you will not need any more treatment.

Sometimes the kidneys will not fully recover and you may be diagnosed with chronic kidney disease or kidney failure. If this happens to you, your doctor will talk to you about the treatment you will need in the future, which could include regular dialysis and referral to a specialist doctor (nephrologist).

As there is a risk of AKI in the future, if you were to become unwell again you should tell all healthcare professionals treating you that you have had AKI in the past. Please check with your Doctor, Nurse or Pharmacist before taking any new medications.

What should I do to prevent it happening again?

As AKI happens suddenly, it can be hard to prevent.

To keep your kidneys healthy:

  • If diabetic, ensure good blood sugar control.
  • Avoid over the counter anti-inflammatory medicines if possible (e.g. ibuprofen).
  • Sick day guidance: if you take medications such as ACE inhibitors/ARB to lower blood pressure (e.g. drugs ending in –pril/-sartan or water tablets), consider withholding these if you become dehydrated for 2-3 days and restarting when you feel better. Please contact your GP/Renal Doctors/Nurse Specialists for further advice.
  • Manage high blood pressure to targets set by your doctor.
  • Avoid dehydration, monitor the colour of your urine, remember healthy wee is 1-3, 4-8 you must hydrate.
colour of urine on a scale of 1-8 regarding hydration
  • Regular exercise.
  • Inform your doctor if you have had AKI in the past.

References/Further Reading

Useful Websites

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers the University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust

Telephone: 01642 624719 / Freephone: 0800 092 0084

Email: [email protected]

Monday to Friday, 9:30 am to 4:00 pm

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).

University Hospital of North Tees

Hardwick Road

Stockton-on-Tees

TS19 8PE

Telephone: 01642 617617

University Hospital of Hartlepool

Holdforth Road

Hartlepool

TS24 9AH

Telephone: 01642 617617

Leaflet Reference: PI063 version 1
Date for Review: 19/05/2029

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