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Acute kidney injury: management

By Sue Shaw, DPharm, MRPharmS, Clare Morlidge, DipClinPharm, MRPharmS, Caroline Ashley, MSc, MRPharmS, and Nick Selby, BMBS, MRCP

Dialysis (Andrei Malov

Management of acute kidney injury depends on the underlying cause and whether the condition is the result of pre-renal, intrinsic or post-renal dysfunction. All patients should have their medicines reviewed


The first step in the management of acute kidney injury (AKI) is identification and treatment of the underlying cause. Management will also depend on the type of AKI — pre-renal, intrinsic or post-renal.  

For patients with pre-renal AKI, the focus is on restoring circulating blood volume and managing blood pressure. Patients thought to have intrinsic AKI should be referred to a nephrologist for further investigation and management. Those with post-renal AKI will most often be referred to a urologist who will address the urinary tract obstruction. In all cases, a patient’s medicines should be reviewed, paying particular attention to medicines that can alter renal haemodynamics, those that are potentially nephrotoxic and those with side effects that could exacerbate AKI. 

Sue Shaw, is a renal pharmacist at Derby Hospitals NHS Foundation Trust, Clare Morlidge is a renal pharmacist at East and North Hertfordshire NHS Trust, Caroline Ashley is a renal pharmacist at Royal Free Hampstead NHS Trust, and Nick Selby is a consultant nephrologist at Derby Hospitals NHS Foundation Trust.


Citation: Clinical Pharmacist URI: 11098638

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