Quality statement 2: Identifying acute kidney injury in people with no obvious acute illness

Quality statement

People who present with an illness with no clear acute component and 1 or more indications or risk factors for acute kidney injury are assessed for this condition.

Rationale

People with acute kidney injury may present with no obvious signs or symptoms of this condition in primary or secondary care settings. Early assessment for acute kidney injury when making decisions about treatment for people who are at risk may prevent delays in treating the condition, leading to improved outcomes. It is important for healthcare professionals to be aware of when it is necessary to assess the risk of acute kidney injury so that a diagnosis is not missed.

Quality measures

Structure

Evidence of local arrangements to ensure that people who present with an illness with no clear acute component and 1 or more indications or risk factors for acute kidney injury are assessed for acute kidney injury.

Data source: Local data collection.

Process

Proportion of presentations of illness with no clear acute component along with 1 or more indications or risk factors for acute kidney injury where an assessment for acute kidney injury is done.

Numerator – the number in the denominator where an assessment for acute kidney injury is done.

Denominator – the number of presentations of illness with no clear acute component along with 1 or more indications or risk factors for acute kidney injury.

Data source: Local data collection.

Outcome

Incidence of acute kidney injury.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (primary and secondary care providers) ensure that people who present with an illness with no clear acute component and 1 or more indications or risk factors for acute kidney injury are assessed for acute kidney injury.

Healthcare professionals consider and assess for acute kidney injury in people who present with an illness with no clear acute component and 1 or more indications or risk factors for acute kidney injury.

Commissioners (clinical commissioning groups) ensure that they commission services in which people who present with an illness with no clear acute component and 1 or more indications or risk factors for acute kidney injury are assessed for acute kidney injury.

What the quality statement means for patients, service users and carers

People who are generally unwell with no obvious recent or sudden illness and who have indications or risk factors for acute kidney injury are assessed to see whether they have this condition. This should include blood tests and having their urine volume measured, as well as reviewing any medications they are taking.

Source guidance

Definitions of terms used in this quality statement

Illness with no clear acute component

A person with an illness with no clear acute component feels generally unwell (for example, tired with perhaps nausea or swelling of the legs), and has no clear idea of when the illness began, and no clear sudden acute illness. [Expert opinion]

Indications or risk factors for acute kidney injury in people with an illness with no clear acute component

The following are indications or risk factors for acute kidney injury in people with an illness with no clear acute component:

  • chronic kidney disease (especially stage 3B, 4 or 5) or urological disease

  • new‑onset or significant worsening of urological symptoms

  • symptoms suggesting complications of acute kidney injury

  • symptoms or signs of a multi‑system disease affecting the kidneys and other organ systems (for example, signs or symptoms of acute kidney injury plus a purpuric rash).

[NICE guideline CG169, recommendation 1.1.4]

Assessment for acute kidney injury

Clinical assessment for acute kidney injury involves doing a blood test to check serum creatinine levels against a previous result, measuring urine volume and reviewing medication. This assessment can be undertaken in a primary care setting as well as a hospital setting, although the frequency of blood testing may be less in a primary care setting. [Expert opinion]

Equality and diversity considerations

All people presenting with no obvious acute illness who have indications or risk factors for acute kidney injury should be assessed for a possible diagnosis. Symptoms suggesting acute kidney injury should not be dismissed based on a person's age – for example, ignoring urological symptoms in older people. Young age, neurological or cognitive impairment or disability may mean that people are less able to describe their symptoms, so it is important that healthcare professionals look out for changes in behaviour that suggest acute kidney injury in these groups.