4 Assessing for AKI in patients with suspected or confirmed COVID-19

4 Assessing for AKI in patients with suspected or confirmed COVID-19

4.1 Be aware that, in patients with COVID‑19, acute kidney injury (AKI):

  • may be common, but prevalence is uncertain and depends on clinical setting (the Intensive Care National Audit and Research Centre's report on COVID-19 in critical care provides information on patients in critical care who need renal replacement therapy for AKI)

  • is associated with an increased risk of dying

  • can develop at any time before or during hospital admission

  • causes may include volume depletion (hypovolaemia), haemodynamic changes, viral infection leading directly to kidney tubular injury, thrombotic vascular processes, glomerular pathology or rhabdomyolysis

  • may be associated with haematuria, proteinuria and abnormal serum electrolyte levels (both increased and decreased serum sodium and potassium).

4.2 Be aware that in patients with COVID‑19:

4.3 On hospital admission or transfer, assess for AKI in all patients. Record:

  • medical history and comorbidities, including factors that further increase the risk of AKI (such as chronic kidney disease, heart failure, liver disease, diabetes, history of AKI, age 65 years or over)

  • fluid status by clinical examination (for example, peripheral perfusion, capillary refill, pulse rate, blood pressure, postural hypotension, jugular venous pressure, or pulmonary or peripheral oedema)

  • fluid status by fluid balance (fluid intake, urine output and weight)

  • full blood count

  • serum urea, creatinine and electrolytes (sodium, potassium, bicarbonate).

    NICE has produced a guideline on acute kidney injury: prevention, detection and management.

4.4 Review the use of medicines that can cause or worsen AKI and stop these unless essential.

4.5 Ask a pharmacist for advice about optimising the choice and dosage of medicines, including anticoagulants for treatment or prophylaxis. See Think Kidneys guidelines for medicines optimisation in patients with acute kidney injury.

4.6 Continue to assess for AKI. Record and monitor fluid status by clinical examination and fluid balance daily. Measure serum urea, creatinine and electrolytes (sodium, potassium, bicarbonate) at least every 48 hours or more often if clinically indicated.

4.7 Use an early warning score for patients whose clinical condition is deteriorating or who have suspected sepsis:

  • NEWS2 has been endorsed by NHS England.

  • When using NEWS2 be aware of the Royal College of Physicians warning that any increase in oxygen requirements should be escalated for clinical review and increased observations.

4.8 Determine the preferred method of monitoring fluid status locally during the COVID‑19 pandemic.