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The Acute Kidney Injury (AKI) Clinic is a Nephrologist-led service, which opened in 2012. The service aims to improve the prevention, earlier detection and management of AKI by providing advice and education to the multidisciplinary team and monitoring patients from diagnosis through to discharge and outpatient follow up.

The AKI clinic runs twice-weekly on Tuesday afternoons to focus on AKI admission avoidance, and on Friday mornings for follow-up patients with AKI.


 

Referral criteria from Primary and Secondary Care include:

  • New AKI stage 1 or 2 in otherwise clinically stable patients
  • Recovering AKI with falling creatinine levels in patients with AKI stage 1, 2 or 3 (excluding patients with renal transplant, or those with known CKD Stage 5, followed up by the Advanced Kidney Care Clinic (AKCC)).
  • Reintroduction of prognostically beneficial medications (including ACE inhibitors/ARBs) following an episode of AKI.

When to refer

See think kidneys guidance for identification and first steps management guidelines available here.

Table 2: Timeframe for response to e-Alert 

AKI Stable patient Acutely unwell patient
Stage 1 < 72 hrs (telephone review) < 24 hrs
Stage 2 < 24 hrs < 6 hrs
Stage 3 See < 6 hrs, Admit Admit



How to refer

To discuss a patient:

AMU Consultant Bleep 7915 (Mon-Fri 9am-9pm)
Renal SpR Bleep 6415 (Mon-Fri 9am-9pm)
Email: akiclinic@stgeorges.nhs.uk (all referrals)



What we do

In clinic, the AKI team:

  • explains what AKI is and the likely cause for the AKI episode
  • undertakes a physical assessment, including blood pressure, urine dipstick and examining for signs of fluid overload
  • reviews the patient’s renal autoimmune disease and myeloma screens, where appropriate, to ensure nothing has been missed which requires follow-up
  • reviews the patient’s medications to assess whether medications stopped due to the AKI can be reinstated
  • will assess whether the patients’ kidney function has returned to normal. This will normally require a specific blood test around the time of the appointment
  • will arrange further imaging or investigations, as required
  • will advise about prevention/progression of chronic kidney disease (CKD), including healthy lifestyle choices, smoking cessation and the avoidance of nephrotoxins, especially NSAIDs.
  • will provide a simple information leaflet which includes all of this advice

After reviewing the patient’s bloods following the clinic appointment, if the creatinine remains elevated or an abnormal renal disease screen is identified, the patient is referred on to the General Nephrology clinic. Otherwise patients are discharged back to GP care with advice on monitoring in line with the NICE CKD guidelines.