Treatment of Acute Kidney Injury: Stage-Based Supportive Management
Acute kidney injury (AKI) requires prompt, structured management tailored to the stage and underlying cause. An evidence-based protocol guides clinicians through the key decisions — from volume status to metabolic correction.
Treatment Approach
The protocol centres on isotonic crystalloid-based intravascular volume management and stage-guided supportive care — with structured guidance covering metabolic complications, drug management, and nutritional support across AKI severity stages.
Key Clinical Target
In critically ill patients with AKI, a primary metabolic goal is plasma glucose maintained at 110–149 mg/dl.
References
DOI: 10.1159/000339789
- In the absence of hemorrhagic shock, we suggest using isotonic crystalloids rather than colloids (albumin or starches) as initial management for expansion of intravascular volume in patients at risk for AKI or with AKI.
- Manage patients with AKI according to the stage and cause.
- Particular attention should be given to the assessment of the circulating volume and fluid administration, the prevention and/or treatment of hyperkalemia and metabolic acidosis, the knowledge of the changes in pharmacokinetics of many drugs with discontinuation of all potentially nephrotoxic drugs, and dose adaptation of drugs excreted by the kidneys to the patient's renal function.
- In critically ill patients, we suggest insulin therapy targeting plasma glucose 110-149 mg/dl (6.1-8.3 mmol/l).