Advancing Quality NHS Advancing Quality Alliance

Acute Kidney Injury

Acute kidney injury (AKI) is caused when there is an abrupt loss of kidney function. AKI can occur when the blood flow to the kidney is decreased, exposure to substances that can harm the kidney or blockages in the urinary tract.

A patient will be diagnosed with acute kidney injury based on the results of blood and urine tests. Elevated blood urea nitrogen and creatinine are indicators that a patient may have AKI.

define:

Urea nitrogen is a normal waste product in your blood that comes from the breakdown of protein from the foods you eat and from your body metabolism. It is normally removed from your blood by your kidneys, but when kidney function slows down, the BUN level rises.

National Kidney Foundation

define:

Creatinine is a waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises.

National Kidney Foundation

The severity of a patient’s AKI is measured and reported through staged alerts; AKI 1, 2 and 3. Through research, clinical input and clinical guidelines Advancing Quality has developed six measures that, when applied at the appropriate time, can greatly increase the outcomes for patients. Advancing Quality uses these measures to monitor the quality of care given to patients across the North West with the aim of improving standards and reducing variation in care.

AKI was launched in April 2015. Participating trusts had a three month data collection period to ensure their systems were accurately recording the care patients received. AKI became part of the AQ conditions in July 2015.

Data for your local hospital will be available by February 2016.


Measures

1. Urine tested within 24 hours of your first AKI Alert

A urine dipstick test, carried out within 24 hours of your first AKI alert is simple and effective in identifying conditions that can be treated to prevent the AKI or reduce its severity.

2. Stop any medication that lowers blood pressure

Research suggests that blood pressure medications may have accounted for 15% of the rise in AKI hospitalisation between 2007/08 and 2010/11. If you are taking blood pressure medication they should be stopped.

3. Blood test to check how your kidneys are functioning within 24 hours of first AKI alert

Timely blood tests can reveal the levels of creatinine in your blood to determine how your kidneys are functioning    Creatinine is a waste product produced by your muscle metabolism; healthy kidneys can filter creatinine into urine.

4. Ultrasound scan within 24 hours of first AKI alert

An ultrasound of your urinary tract should be carried out within 24 hours of the first AKI alert to check for any causes or if the urinary tract is blocked.

5. Discussion by specialists within 12 hours of your first AKI 3 alert

A timely referral to specialists will ensure that you have the appropriate care as soon as possible, improving the outcomes for the patient.

6. Self-management information

Information about self-management, monitoring and any future treatments should be given to you, and where appropriate your carers.
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