Acute Kidney Injury (AKI) — KDIGO Staging & Management

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] AKI diagnosis
   Does it meet AKI criteria? (AKI (any one): SCr rise ≥26.5 µmol/L (0.3 mg/dL) within 48 h; or SCr ≥1.5× baseline within 7 days; or urine output <0.5 mL/kg/h for ≥6 h.)
   • Meets AKI → KDIGO staging
   • Does not meet → AKI not met
2. [End] AKI not met
   Monitor SCr and urine output dynamically; assess and control risk factors (hypovolemia, nephrotoxins, contrast, sepsis) and recheck as needed.
3. [Decision] KDIGO staging
   KDIGO stage? (Stage 1: SCr 1.5–1.9× baseline or rise ≥26.5 µmol/L; urine <0.5 mL/kg/h for 6–12 h. Stage 2: SCr 2.0–2.9× baseline; urine <0.5 mL/kg/h ≥12 h. Stage 3: SCr ≥3× baseline or rise to ≥353.6 µmol/L (4 mg/dL) or start of dialysis; urine <0.3 mL/kg/h ≥24 h or anuria ≥12 h.)
   • Stage 1–2 → Stage 1–2
   • Stage 3 → Stage 3
4. [End] Stage 1–2
   Find and correct the cause (pre-renal volume/perfusion, renal, post-renal obstruction — check urine sediment, renal ultrasound to exclude obstruction); stop nephrotoxins and contrast, adjust doses for renal function; optimize volume and hemodynamics (avoid fluid overload); monitor electrolytes/acid-base, SCr and urine output; treat complications.
5. [End] Stage 3
   On top of stage 1–2 management, monitor closely (ICU if needed); aggressively treat complications (hyperkalemia, metabolic acidosis, fluid overload, uremia). Renal replacement therapy (RRT) indications (AEIOU): refractory acidosis, electrolyte disturbance (hyperkalemia), intoxication, fluid overload, uremic symptoms (encephalopathy/pericarditis). Consult nephrology / critical care.

Source guidelines & references

• KDIGO 2012 Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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