Acute kidney injury Information for patients Sheffield Teaching Hospitals
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Acute kidney injury You have been given this leaflet because you have had an episode of acute kidney injury (AKI). We hope that we have answered all your questions, but if you would like more information, we explain where you can get this at the end of the leaflet. What are the kidneys and what do they do? Most people have two kidneys at the bottom of their ribcage at the back. Your kidneys do several important jobs to keep you healthy: Filter waste products, toxins and drugs from the blood - which are passed out in your urine. Control the amount of water (fluid) in the body - making sure you don't have too much water (called fluid overload) or too little water (called dehydration). Help control your blood pressure - so it doesn't get too high or too low. Help make vitamin D work - which keeps your bones healthy and strong. Make a hormone which is needed to make red blood cells. Control the amount of salt (sodium), potassium and calcium which helps your heart work properly. Control the acidity of your blood. What is acute kidney injury (AKI)? AKI is when your kidneys stop working properly usually within a short period, typically a few hours to a few days. Often AKI happens without any symptoms so you would not always realise anything was wrong at the beginning. It is estimated that 1 in 5 people admitted to hospital each year as an emergency has AKI. page 3 of 12
What causes AKI? AKI can be caused by many different conditions. Some of these are: Lack of blood going to the kidney - during an episode of low blood pressure. There are a number of causes of low blood pressure, including dehydration, bleeding and severe infection. Certain types of medication can be damaging to the kidney. Inflammation inside the kidney - often caused by an over-active immune system or a reaction to some medications. Blockages in the drainage system of the kidneys, the tubes leading to or from the bladder. This may be due to kidney stones or an enlarged prostate in men. Your doctor will explain to you what may have caused your AKI. Please ask as many questions as you need. What was the cause of my AKI? Could it have been prevented? page 4 of 12
Is there anything which increases the risk of AKI? There are some conditions (risk factors) that make AKI more likely: Age AKI is more common in people over 65. Diabetes. Vascular disease for example heart disease, stroke or other major circulation problems. Having had AKI in the past. A history of chronic kidney disease (CKD) a gradual loss of kidney function over a long time. Do I have any risk factors that made me more likely to get AKI? How does the doctor know I have AKI? The doctor will know you have AKI from the results of tests that will be carried out on your blood and urine. These tests would show: High creatinine level in the blood. Passing less urine than normal. You may also need an ultrasound or CT scan of your kidneys to help identify the problem. page 5 of 12
How is AKI treated? Your treatment will depend on the cause of your AKI, but in some cases the reason is not known. Most patients need a scan of their kidneys to make sure there is no blockage. You may need a biopsy (taking a very small sample of the kidney) if the cause of your AKI is not clear. Often the kidneys get better by themselves, especially if there is a clear cause that can be treated, such as dehydration, infection or certain types of inflammation. Treatment for AKI can include: Solving the cause of the problem, for example A drip to give fluids through a vein in your arm if you are dehydrated or finding it difficult to drink. Antibiotics to treat infection. Review of the medications you take some of these may need to be stopped and others reduced. A very small number of patients, less than 5 in 100 (5%) need dialysis (treatment on a kidney machine) to remove the waste products in the blood and excess water that has built up in the body. Less commonly, certain types of inflammation need specific medication and rarely a form of blood cleaning treatment called plasma exchange (done on a machine). While you are in hospital, you will be closely monitored by staff. This will include: Regular monitoring of your blood pressure, pulse, temperature, breathing rate and oxygen levels. page 6 of 12
Measuring how much fluid you are drinking. Measuring how much urine you are passing. You may need a catheter inserted to make sure this is as accurate as possible. Recording what you eat on a food chart. You may need to be seen by a dietitian if you are not eating well or need some changes to your diet. Being weighed every day. Blood tests every day. If you have any questions about your treatment, please ask the staff involved in your care. What if I have diabetes? Some people with diabetes find their blood sugar is difficult to control when they are unwell, and so may need to start treatment with insulin even if they have not needed it before. You may need your blood sugar tested more often while you are ill. Many medications used to treat diabetes are removed from the body by the kidneys. If the kidneys are not working properly, the levels can build up in the blood and increase the risk of side effects. Your doctor may need to change your medications because of this. Ask your doctor if you have any concerns about this. Will there be any long term effect on my health and my kidneys? With prompt treatment you may only have suffered mild kidney damage. If you had healthy kidneys before your illness and no other underlying health problems, it is likely your kidney function will improve and you should have no lasting problems. page 7 of 12
AKI is a serious condition and unfortunately some patients do not survive, especially if the AKI is severe enough to need dialysis treatment. Most patients who do not need dialysis improve. For those patients that do need dialysis, only about 10-20 in 100 (10-20%) will need to stay on it for the rest of their lives. If this is the case with you, our team of renal doctors, nurses and other specialist staff will support you. There will be chance for you and your family to ask any questions that you have. Some patients will end up with reduced kidney function, known as chronic kidney disease (CKD). This may not be bad enough to need dialysis but must be followed up regularly by either your GP or kidney doctors. This may include: Blood tests to monitor your kidney function. Changes to the medications you take. Regular monitoring of your blood pressure. Changes to your diet. Clinic visits under the care of a specialist kidney (renal) doctor. What happens when I go home? If the episode of AKI was short and your kidney function has returned to normal, you may not need further follow up. If the episode of AKI was longer and more severe, then you will need to be seen either by your GP or at the specialist renal clinic. The doctor will need to carry on monitoring you, for example by checking your blood results, blood pressure and medication. At the time you leave hospital, we may not be sure how well your kidneys will recover or how long this may take. Everyone is different and our bodies react and recover in different ways. page 8 of 12
When you go home, you may be surprised how tired you feel. You may need someone to help you with heavier household jobs for a few weeks (for example vacuuming or gardening). You can slowly increase the amount that you do and that feels comfortable. In most cases, your strength and stamina will slowly return. You may have seen a physiotherapist or occupational therapist while you were in hospital. If you need further support at home, this will be arranged for you. page 9 of 12
Is there anything I can do to stop this happening again? Anybody who has had an episode of AKI is at a higher risk of another episode in the future. There are things you can do to lessen the chances of it happening again. Any illness or situation that leads to dehydration (short of fluid) or a low blood pressure puts you at risk of AKI. The most common reasons for becoming dehydrated are: Vomiting. Diarrhoea. High temperature or fevers. Not being able to drink normally. If you do have any of these, try to drink more. If your symptoms carry on for more than 24 48 hours, you must see your GP. Explain to them that you have had AKI in the past while you were in hospital. Your GP will check your blood levels and may need to change some medication as some types of medicine can stop the kidneys working as they should. Other things that you can do include: Stop smoking. See your GP or pharmacist for help with this. Avoid high blood pressure. Have your blood pressure checked and take any medication regularly. When you are unwell, for example with a urine (water) infection or diarrhoea, have a blood pressure medication "holiday". This is to stop your blood pressure going too low and you getting AKI again. Ask your hospital team or GP which medication you should stop and for how long. page 10 of 12
The names of the medications I should stop are: I should stop taking them for days. Avoid a group of drugs called anti-inflammatory medications (for example the painkiller ibuprofen). Ask the pharmacist at the chemist if you have any questions about this. Keep your alcohol intake to the recommended limits. Ask at your GP surgery or chemist about this. Lose any excess weight. Again, ask your GP or pharmacist about help and support available. Taking regular exercise as advised by your doctor. Eat healthily. Restricting your salt intake may be helpful. If you need more advice about this, ask at your GP surgery. page 11 of 12
Where can I find further information? You can find out more information about AKI from: The British Kidney Patients Association at: http://www.britishkidney-pa.co.uk/patient-info The NHS Choices website at: http://www.nhs.uk/conditions/acute-kidney-injury/pages/in troduction.aspx The NHS Choices website also has information on healthy living including, for example, advice on stopping smoking, alcohol intake and eating healthily: http://www.nhs.uk/livewell/pages/livewellhub.aspx NHS England has a website called "Think kidneys". You will be able to hear the stories of other people who have had AKI, and see what healthcare staff are doing to learn more and reduce the risk of this condition happening: https://www.thinkkidneys.nhs.uk/aki/ Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more www.sheffieldhospitalscharity.org.uk Registered Charity No 1059043 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD7986-PIL3344 v2 Issue Date: December 2016. Review Date: December 2018