When the Kidneys Stop Working (25 July 2022)
Play • 44 min
Dr Jonathan Bardgett interviews Dr Damian Fogarty on why Acute Kidney Injury and Chronic Kidney Disease is so important and talk through cases to give tips on managing a patient in the acute take.

Dr Fogarty is a Consultant Nephrologist in the Belfast Trust. His current post, in a tertiary referral centre, manages patients with Acute Kidney Injury and Chronic Kidney Disease including those requiring dialysis or transplantation.


--Useful Information--
This podcast although pre-recorded is a spontaneous conversation & as such recommendations and advice need taken in context with written and proof-read reviews such as within these references:

Acute kidney injury: prevention, detection and management
NICE guideline Published: 18 December 2019
PDF at https://www.nice.org.uk/guidance/ng148/resources/acute-kidney-injury-prevention-detection-and-management-pdf-66141786535621

BMJ Quality Improvement Programme
Acute Kidney Injury: It’s as easy as ABCDE
Caroline Forde, Jennifer McCaughan, Niall Leonard
BMJ Quality Improvement Reports 2013; 2, No. 1 u200370.w326 doi: 10.1136/bmjquality.u200370.w326
The 'ABCDE' checklist (Address drugs, Boost blood pressure, Calculate fluid balance, Dip urine, Exclude obstruction) was introduced to prompt AKI management.

In NHS England there is a mandated AKI programme under the umbrella term of ‘Think Kidneys’ (https://www.thinkkidneys.nhs.uk/).
As part of this there is a national audit with data collection using laboratory AKI e-alerts and managed by the UK Renal Registry-UK Kidney Association in association with NHS England.
This service estimates that one in five emergency admissions into hospital are associated with acute kidney injury and potentially up to 100,000 deaths in secondary care are associated with acute kidney injury with perhaps 25-30% potentially preventable.
(National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Adding Insult to Injury 2009)https://www.ncepod.org.uk/2009aki.html.

AKIN stages:
An increase of more than 26μmol/l above baseline (within a 48hr period)
OR An increase of more than or equal to 1.5 to 2 fold from baseline
An increase of more than or equal to 2 to 3 fold from baseline
An increase of more than 3 fold from baseline
Serum creatinine ≥355μmol/l with an acute rise of at least 45μmol/l
Initiation of RRT

Recording date: 30 May 2022

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