Acute Kidney Injury; Roadside to Resus

Acute kidney injury (AKI) represents an abrupt, hours-long decline in renal function, affecting up to 20% of general hospital admissions and 50% of critical care patients. Clinicians categorize AKI into pre-renal, intrinsic, and post-renal aetiologies to guide targeted interventions. Effective assessment requires a thorough clinical history, physical examination for fluid status, and 12-lead ECG monitoring to detect hyperkalemia-induced cardiac changes. Management centers on limiting further damage by addressing underlying causes like sepsis or hypovolemia, carefully titrating fluid resuscitation to avoid overload, and discontinuing nephrotoxic medications such as ACE inhibitors and NSAIDs. While serum creatinine and urine output serve as primary diagnostic markers, clinicians must account for the time-lag in biochemical changes. When medical management fails to address severe electrolyte imbalances, metabolic acidosis, or uremic complications, immediate referral for renal replacement therapy is essential.