A fictional 72-year-old with diarrhoea and several nephrotoxic medicines develops oliguria, rising creatinine and increasing breathlessness.
Frame the danger first.
- Use creatinine change and urine output to recognise acute kidney injury and establish the trajectory.
- Assess volume status, obstruction, sepsis, medicines and intrinsic renal disease in parallel.
- Look immediately for hyperkalaemia, acidosis, pulmonary oedema and uraemic complications.
Act, escalate, reassess.
- Begin ABCDE assessment and treat shock, sepsis or respiratory compromise using current local pathways.
- Review and withhold contributing medicines where clinically appropriate, adjusting doses for renal function.
- Measure fluid balance, perform focused investigations and arrange urinary-tract imaging when obstruction is possible.
- Discuss urgently with renal/critical care when complications may require renal replacement therapy.
Red flags that change pace.
- Refractory hyperkalaemia, severe acidosis or pulmonary oedema
- Persistent oliguria/anuria, rapidly rising creatinine or suspected obstruction
- Multisystem disease, transplant kidney or features of glomerulonephritis/vasculitis
What makes care less safe.
- Giving repeated fluid challenges without reassessing volume and respiratory status
- Focusing on creatinine while missing urine-output decline or dangerous complications
- Delaying renal discussion until every investigation is complete
Say the concern plainly.
Acute kidney injury with creatinine [baseline/current/trend], urine output [amount/time], volume assessment [summary] and complications [list]. Reversible causes and medicines reviewed are [summary]. I need renal/critical-care advice about [specific threat].