This guideline covers preventing, detecting and managing acute kidney injury in children, young people and adults. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. This will improve early recognition and treatment, and reduce the risk of complications in people with acute kidney injury.

 For additional information on managing acute kidney injury in patients in hospital with COVID-19, see assessing and managing acute kidney injury in our COVID-19 rapid guideline on managing COVID-19

Last reviewed: 28 September 2023

We updated recommendations on offering iodine-based contrast media to adults to clarify that, for non-emergency imaging, an estimated glomerular filtration rate (eGFR) measurement is only needed if the person is at increased risk of kidney injury. See the update information for details.

This guideline updates and replaces NICE guideline CG169 (August 2013)

Future updates: We will update the recommendations on assessing risk factors for acute kidney injury in adults having iodine-based contrast media. For more information, see the surveillance decision.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners and providers
  • People with or at risk of acute kidney injury and their families and carers

Guideline development process

How we develop NICE guidelines

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.