Patient handout

Acute Kidney Injury

PRODUCTION

1. Your condition

This handout is for acute kidney injury. Your care team identified this based on: creatinine rise ≥0.3 mg/dl in 48h or ≥1.5x baseline in 7d (kdigo 2012 aki).

Other reasons your team may use this plan: urine output <0.5 ml/kg/h × ≥6h (kdigo 2012 aki); new anuria or decreased urine output (kdigo 2012 aki); hyperkalemia or acidosis on routine bmp (kdigo 2012 aki aeiou).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
lactated_ringers	10-20 mL/kg bolus	IV	titrate to MAP >65 + UOP >0.5 mL/kg/h	SMART Semler NEJM 2018 + SALT-ED — balanced crystalloid superior to saline for MAKE30; prevents hyperchloremic acidosis (KDIGO 2012 AKI)
sodium_chloride_0.9%	10-20 mL/kg bolus	IV	titrate	Acceptable when balanced unavailable; avoid large-volume to prevent hyperchloremic acidosis (KDIGO 2012 AKI)

Plan: KDIGO 2012 AKI bundle — phenotype-driven volume / nephrotoxin / RRT (KDIGO 2012 AKI; STARRT-AKI NEJM 2020; SMART NEJM 2018)

3. When to call your provider

Contact your care team if any of the following happen:

Sustained eGFR <60 at 3 months → transition to neph.ckd.core.v1 (KDIGO 2024 CKD)
Recurrent AKI → nephrology + comprehensive evaluation (KDIGO 2012 AKI)
Worsening proteinuria → consider GN workup → route renal.rpgn.core.v1 if active sediment (KDIGO 2021 GN)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

KDIGO Stage 3 AKI — Cr ≥3× baseline OR Cr ≥4.0 mg/dL OR UOP <0.3 mL/kg/h × ≥24h OR anuria ≥12h OR RRT initiated (KDIGO 2012 AKI)
Intrinsic AKI — Acute Tubular Necrosis; ischemic or nephrotoxic; FENa >2%, BUN:Cr <15, muddy-brown granular casts (KDIGO 2012 AKI)
Intrinsic glomerular AKI — nephritic (RPGN) or nephrotic; RBC casts + dysmorphic RBCs + proteinuria → route renal.rpgn.core.v1 (KDIGO 2021 GN)(life-threatening)
Intrinsic vascular AKI — renal vein thrombosis / atheroembolic / TTP-HUS / scleroderma renal crisis (KDIGO 2012 AKI)
Post-renal AKI — obstruction (BPH/pelvic mass/bilateral stones/single-kidney obstruction); hydronephrosis on imaging (KDIGO 2012 AKI)
Hepatorenal syndrome per ICA 2019 — cirrhosis + AKI not responsive to 48h albumin challenge + no shock + no nephrotoxin (AASLD 2023; ICA 2019)
Sepsis-associated AKI — most common ICU AKI; multifactorial (hypoperfusion + cytokine + drugs) (SSC 2026; KDIGO 2012 AKI)
Rhabdomyolysis-AKI — CK >5000 U/L + myoglobinuria + hyperK; crush/exertion/seizure/statin/drug (KDIGO 2012 AKI)
Tumor lysis syndrome — hyperK + hyperPhos + hyperuricemia + hypoCa post-chemo or hematologic malignancy (Cairo-Bishop)(life-threatening)
Cardiorenal syndrome Types 1-5 (Ronco) — AKI from acute/chronic cardiac dysfunction or vice versa (KDIGO 2012 AKI)
AEIOU Acidosis — pH <7.1 OR HCO3 <10 not responsive to bicarbonate (KDIGO 2012 AKI; STARRT-AKI NEJM 2020)(life-threatening)
AEIOU Electrolytes — K >6.5 OR ECG changes despite shift therapy + binder (KDIGO 2012 AKI)(life-threatening)
AEIOU Overload — pulmonary edema refractory to high-dose IV loop diuretic (KDIGO 2012 AKI; DOSE NEJM 2011)
AEIOU Uremia — encephalopathy / pericarditis / bleeding diathesis with BUN >100 (KDIGO 2012 AKI)

5. Follow-up

Recheck Cr 1 week post-discharge; nephrology outpatient; 3-month reassessment for CKD progression; med-rec post-AKI; recurrent AKI risk modification (KDIGO 2012 AKI; KDIGO 2024 CKD)

6. Sources

Guideline: KDIGO 2012 AKI Guideline (binding) + KDIGO 2026 AKI/AKD draft (public review) + STARRT-AKI NEJM 2020 + AKIKI NEJM 2016 + IDEAL-ICU NEJM 2018 + SMART/SALT-ED NEJM 2018 + DOSE NEJM 2011 + PRESERVE NEJM 2018 + CONFIRM NEJM 2021 (HRS) + AASLD 2023 ACLF + SSC 2026 sepsis + KDIGO 2024 CKD progression