This article was last reviewed on
This article waslast modified on 10 July 2017.

The National Institute for Health and Care Excellence (NICE) have recently published guidance on acute kidney injury, (http://guidance.nice.org.uk/CG169) a condition that refers to the loss of kidney function over hours or days. The condition is described as ‘acute’ to distinguish it from chronic kidney disease, where kidney function may gradually decline over many months to years. Acute kidney injury is seen in 13-18% of all people admitted to hospital and particularly affects older patients.

Media coverage of the guidance release has focused on claims that following the guidelines could save ‘at least 12,000 lives’ per year. Articles have also described how the condition can be identified with a ‘simple blood test’ known as serum creatinine.

Serum creatinine is a marker of kidney function and is one of the most common blood tests performed in the UK, with millions of measurements throughout the country each year. In acute kidney injury, the concentration of serum creatinine within the bloodstream increases, as the kidneys are no longer able to effectively filter small molecules like creatinine out of the blood and into the urine.

The NICE CG169 guidance on acute kidney injury recommends that serum creatinine is regularly measured in patients who are unwell and who have any of a wide range of risk factors. These risk factors include chronic kidney disease, heart failure, liver disease, diabetes, dehydration and the use of certain drugs that can affect the kidney.

Laboratory medicine professionals are currently exploring ways to help doctors and nurses quickly notice increases in serum creatinine that could indicate acute kidney injury. In July 2013 a working group set up by The Association for Clinical Biochemistry and Laboratory Medicine (ACB), brought together Renal Physicians, Biochemists and the companies responsible for laboratory medicine computer systems to design a standardised method of electronically alerting healthcare professionals to acute kidney injury. This has now led to the formation of an Acute Kidney Injury Programme Board at NHS England which will ensure that the framework for the required action to improve care for patients developing acute kidney injury is in place.

Dr Robert Hill, Director of Scientific affairs at the ACB said
“There is a real enthusiasm among health professionals to develop a robust “early warning system” that will detect at risk patients before they develop severe kidney failure. Treating these patients early will have a real impact on reducing their hospital stay and preventing future kidney problems”

Some laboratories already have local systems in place to alert doctors and nurses to rising levels of serum creatinine, including telephoning abnormal results to the requesting clinician, and/or adding interpretative comments to results. It is hoped that the once developed, the new acute kidney injury alert system will work across all laboratory medicine computer systems to standardise this practice across the UK and therefore provide standardised care for all NHS patients.