How should I approach the management of a patient presenting with acute kidney injury in primary care?

In primary care, manage a patient presenting with acute kidney injury (AKI) by first assessing the stage of AKI, the person's age, comorbidities, risk of complications, and social situation to determine whether hospital admission, specialist liaison, or ongoing primary care management is appropriate ¹.

If the patient has likely stage 3 AKI, no identifiable cause, or signs of urological obstruction, sepsis, hypovolaemia needing IV fluids, deterioration, or life-threatening complications, arrange urgent hospital admission or same-day referral ².

For stage 1 or 2 AKI without immediate indications for hospitalisation, manage in primary care by treating the underlying cause if resources allow, offering supportive advice on fluid balance, and considering temporary medication adjustments, such as stopping or dose-reducing ACE inhibitors or ARBs during intercurrent illness ¹.

Monitor serum creatinine regularly, typically daily in hospital, and perform urine dipstick testing for blood, protein, leucocytes, nitrites, and glucose to identify causes or complications ³.

Consider urgent ultrasound if no cause is identified or if urinary obstruction is suspected, and refer to a urologist if upper tract obstruction or pyonephrosis is present ³.

Discuss with a nephrologist or specialist if there is uncertainty about management, moderate hyperkalaemia (serum potassium 6.0–6.4 mmol/L), or if the patient is not responding to primary care treatment ².