Role and principles
Judge kidney recovery after acute injury, communicate residual risk, restore beneficial medicines safely, and arrange proportionate biochemical, albuminuria and clinical follow-up across the hospital–primary care boundary.
Kidney recovery ranges from rapid return to the previous baseline through partial recovery, recurrent injury, prolonged dialysis dependence and transition to chronic kidney disease. Creatinine may fall because filtration improves, but it can also fall as muscle mass declines after critical illness; fluid balance also changes its concentration. A robust judgement uses serial values, urine output, clinical state and the original baseline. The term ‘resolved AKI’ should therefore be accompanied by evidence and a plan rather than treated as a discharge endpoint.
Follow-up intensity reflects residual risk. Severe stage, prolonged oliguria, renal replacement therapy, incomplete recovery, heart failure, transplant, significant albuminuria, recurrent episodes and an uncertain or intrinsic cause justify earlier testing and specialist input. A stable person with fully recovered mild haemodynamic AKI may need less urgent review, but still needs documentation and medicine reconciliation. NICE deliberately does not impose one universal interval: timing depends on stability and impairment at discharge.