Sick Day Guidance for an Acute Kidney Injury (AKI)

When you have a kidney condition, becoming unwell can put additional strain on your kidneys and increase the risk of complications, such as acute kidney injury (AKI).

This leaflet provides information on the steps that you should take if you develop an illness that causes your body to become dehydrated (short of fluid). These steps are commonly referred to as ‘Medicine Sick Day Rules’.

This guidance should empower you to safely and proactively manage your condition during sick days.

What is an acute kidney injury?

AKI is a sudden decline in kidney function. The most common causes for AKI are:

• Dehydration (not getting enough fluid, or losing too much fluid from the body), e.g. due to diarrhoea, vomiting, fever, or not being able to drink normally
• Severe infection (e.g., sepsis)
• Certain medicines that affect the way the kidneys work
• Blockages in the urinary tract (e.g. kidney stones)
• Pre-existing kidney problems, or other conditions that affect the kidneys (e.g. diabetes, heart disease)

The effects usually occur over a few days. Severity may range from minor loss in kidney function, to complete kidney failure. Early detection and intervention gives your kidneys a better chance at recovery.

What is the function of the kidneys?

The kidneys are vital organs that help to keep the body healthy. Their roles include:

• Removing waste products from the blood, and making urine
• Keeping your blood pressure level
• Keeping fluid balance level (by removing excess fluid and ensuring you are not too dry).
• Controlling the acid found in blood
• Controlling the production of red blood cells.

Symptoms of an AKI

• Reduced urine output
• Swelling in legs, ankles, or around the eyes
• Shortness of breath
• Fatigue and confusion
• Nausea, vomiting, loss of appetite.

Not all people develop the above symptoms. Sometimes there are no signs that the kidneys have stopped working, and this can be picked up on blood tests.

Why sick day guidance is important

When you are unwell, especially with vomiting, diarrhoea or fever, you are at higher risk of AKI. This is because dehydration reduces blood flow to the kidneys, and infections can cause inflammation that affects kidney function. Following sick day rules can help reduce the impact of illness on your kidneys.

Sick day rules

When you are unwell with any of the following:

• Vomiting or diarrhoea (unless only minor)
• Fevers, sweats and shaking

1. Temporarily stop taking the medicines listed in ‘medicines box’’ (see below)
2. Once you are feeling better (after 24-48 hours of eating and drinking normally),restart those medicines.
3. Contact your pharmacist, doctor or nurse if you are not sure about whether to stop a medicine, or if you remain unwell for longer than 48 hours.

Medicines box

ACE Inhibitors: medicines ending in ‘pril’ e.g. lisinopril, perindopril, ramipril

Angiotensin Receptor Blockers (ARBs): medicines ending in ‘sartan’ e.g. losartan, candesartan, valsartan

Non-Steroidal Anti-Inflammatory drugs (NSAIDs): e.g. ibuprofen, diclofenac, naproxen

Diuretics (‘water pills’): e.g. furosemide, spirolactone, indapamide, bendroflumethiazide

Metformin (a diabetes medicine)

SGLT-2 inhibitors (diabetes medicines): e.g dapagliflozin, empagliflozin, canagliflozin

Ways to monitor your symptoms at home

• Monitor your weight: Sudden weight gain or loss can indicate fluid imbalances.
• Measure your blood pressure: High or low blood pressure can be a sign of worsening kidney function.

Warning signs that require immediate attention

• Persistent diarrhoea or vomiting
• Inability to keep fluids down
• Signs of dehydration (e.g., dry mouth, dark urine, dizziness)
• Severe swelling or shortness of breath
• Confusion or difficulty concentrating
• Sudden changes in urine output.

Conclusion

We hope that you have found this information useful. Following the sick day guidance and keeping in contact with your hospital doctor and GP can help you protect your kidneys during times of sickness. We recommend you keep this leaflet close to you as a reminder of sick day guidance. It is intended for information purposes only, and does not constitute replacement for advice from your healthcare provider.

Contact numbers

If you have any questions, or are worried about anything, please contact the Renal Department at Dorset County Hospital, your GP, or NHS 111.

Useful websites

NHS Choices: https://www.nhs.uk/conditions/acute-kidney-injury/

About this leaflet

Author(s): Dr Electra Botsa, Foundation Year 2 Doctor
Written: August 2024
Approved: August 2024
Review date: August 2027
Edition: 1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk