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Renal
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Acute Kidney Injury
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Pre-renal vs intrinsic vs post-renal; FENa and UA help.
Decision
Outcome
Decision
AKI — categorize first?
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Pre-renal vs intrinsic vs post-renal
Decision
Initial workup?
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Urine output, BUN/Cr ratio, FENa or FEUrea, urinalysis with sediment, renal US
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Renal biopsy first
Decision
Pattern?
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BUN/Cr >20, FENa <1%, bland sediment, responds to fluids → pre-renal
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Hydronephrosis on US → post-renal (obstruction)
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Muddy brown casts → ATN
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RBC casts + proteinuria → glomerulonephritis
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WBC casts + eos → interstitial nephritis (drug)
Outcome
Volume resuscitation; address heart failure if cardiorenal
Outcome
Relieve obstruction (catheter, stent, nephrostomy)
Outcome
Supportive; avoid further nephrotoxins; dialysis if AEIOU criteria
AEIOU: Acidosis, Electrolytes (hyperK), Ingestion (toxins), Overload, Uremia.
Outcome
Nephrology referral; biopsy; treat underlying (steroids, immunosuppressants)
Outcome
Stop offending drug (PPI, NSAID, β-lactam, sulfa); steroids if persistent
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