• Control hypertension/hypotension.
• Correct electrolyte abnormalities.
• Control acidemia.
• Avoid fluid overload.
• Monitor patients closely for cardiac complications.

Fluid balance

• Keep the patient euvolaemic: avoid intravascular hypo- and hypervolaemia.
• If euvolaemic: restrict the daily fluid intake to 500 mL plus the previous day's measured losses (urine, nasogastric drainage, etc.), allowing more if the patient is febrile (500 mL for each °C of fever).
• The patient's fluid status should be assessed twice daily (by weighing and fluid balance chart) and the next 12hours' fluids adjusted appropriately.

Diet

• Aim for an energy intake 20–30kcal/kg/d.
• Restrict sodium and potassium content to <50 mmol/day.
• Restrict dietary phosphate to <800 mg/day.
• Protein intake should not be restricted.
• Consider enteral or parenteral nutrition if renal failure is prolonged or the patient is hypercatabolic.

Potassium

• Stop potassium supplements and potassium-retaining drugs.
• Restrict dietary potassium intake to <50 mmol/day.
• If plasma potassium rises above 6 mmol/L despite dietary restriction, start calcium resonium, which may be given orally (15g 8-hourly PO) or by retention enema (30g) (high risk of constipation, therefore add laxatives).

Infection

• Patients with AKI are vulnerable to infection, especially pneumonia and urinary tract infection.
• Urinary catheters and vascular lines should be removed wherever possible.
• If the patient develops fever or unexplained hypotension, search for a focus of infection, send blood and urine for culture and start antibiotic therapy to cover both Gram-positive and negative organisms (e.g. third-generation cephalosporin).

Gastrointestinal bleeding

• Gastrointestinal bleeding occurs in 10–30% of patients with AKI.
• Start prophylactic therapy with a proton pump inhibitor or H2-receptor antagonist.

Drugs and contrast media

• Make sure all drug dosages are adjusted appropriately: consult the section on Prescribing in renal impairment in the British National Formulary.