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Emergency Medicine International
Volume 2012, Article ID 760623, 6 pages
Review Article

Care of the Critically Ill Emergency Department Patient with Acute Kidney Injury

Department of Critical Care, King’s Health Partners, Guy’s & St Thomas’ Foundation Trust, King’s College London, London SE1 7EH, UK

Received 9 August 2011; Accepted 14 October 2011

Academic Editor: Peter DeBlieux

Copyright © 2012 Jennifer Joslin and Marlies Ostermann. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Acute Kidney Injury (AKI) is common and associated with significant mortality and complications. Exact data on the epidemiology of AKI in the Emergency Department (ED) are sparse. This review aims to summarise the key principles for managing AKI patients in the ED. Principal Findings. Timely resuscitation, goal-directed correction of fluid depletion and hypotension, and appropriate management of the underlying illness are essential in preventing or limiting AKI. There is no specific curative therapy for AKI. Key principles of secondary prevention are identification of patients with early AKI, discontinuation of nephrotoxic medication where possible, attention to fluid resuscitation, and awareness of the risks of contrast-induced nephropathy. In patients with advanced AKI, arrangements for renal replacement therapy need to be made before the onset of life-threatening uraemic complications. Conclusions. Research and guidelines regarding AKI in the ED are lacking and AKI practice from critical care departments should be adopted.