Last reviewed: November 2017
Last updated: December  2017

Summary

Definition

History and exam

Key diagnostic factors

  • reduced urine production
  • vomiting
  • dizziness
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • muscle tenderness
  • limb ischemia
  • seizures
  • prostatic obstructive symptoms
  • hematuria
  • pulmonary edema
  • hypotension
  • tachycardia
  • orthostatic hypotension
  • fever
  • rash
  • arthralgia/arthritis
  • hypertension
  • peripheral edema
  • altered mental status
  • signs of uremia

Other diagnostic factors

  • nausea
  • thirst
  • flank pain
  • abdominal distention
  • abdominal bruit
  • livedo reticularis
  • petechiae
  • ecchymoses

Risk factors

  • advanced age
  • underlying renal disease
  • malignant hypertension
  • diabetes mellitus
  • myeloproliferative disorders, such as multiple myeloma
  • connective tissue disease
  • sodium-retaining states (e.g., CHF, cirrhosis, nephrotic syndrome)
  • radiocontrast
  • exposure to nephrotoxins (e.g., aminoglycosides, cancer therapies, NSAIDs, or ACE inhibitors)
  • trauma
  • hemorrhage
  • sepsis
  • pancreatitis
  • drug overdose
  • surgery
  • cardiac arrest
  • recent vascular intervention
  • excessive fluid loss
  • nephrolithiasis
  • drug abuse
  • alcohol abuse
  • excessive exercise
  • recent blood transfusion
  • malignancy
  • genetic susceptibility
  • use of renin-angiotensin system inhibitors

Diagnostic investigations

1st investigations to order

  • basic metabolic profile (including BUN and creatinine)
  • ratio of serum BUN to creatinine
  • urinalysis
  • urine culture
  • CBC
  • fractional excretion of sodium
  • fractional excretion of urea
  • urinary eosinophil count
  • venous blood gases
  • fluid challenge
  • bladder catheterization
  • urine osmolality
  • urine sodium concentration
  • renal ultrasound
  • CXR
  • ECG
Full details

Investigations to consider

  • ANA
  • anti-DNA
  • complement (C3, C4, CH50)
  • antiglomerular basement membrane
  • antineutrophil cytoplasmic antibodies (ANCA)
  • acute hepatitis profile
  • HIV serology
  • cryoglobulins
  • ESR
  • antistreptolysin-O antibody
  • abdominal CT or MR scan
  • nuclear renal flow scan
  • cystoscopy
  • renal biopsy
Full details

Emerging tests

  • novel serum and urinary biomarkers
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine

Nephrology Division

Stanford University Medical Center

Stanford

CA

Disclosures

RL works as a consultant and researcher for Relypsa, Inc. Although unrelated to this topic area, RL also works as a consultant for Fibrogen, Inc.; Mallinckrodt, Inc.; and Alexion, Inc.; and as a researcher for Genentech, Inc.; Mallinckrodt, Inc.; GlaxoSK, Inc.; Rigel, Inc.; Aurinia, Inc.; and the NIH.

Dr Richard Lafayette would like to gratefully acknowledge Dr Sandra Sabatini, Dr Neil Kurtzman, and Dr Corey D. Ball, the previous contributors to this monograph. SS, NK, and CDB declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Section of Nephrology

Department of Medicine

Baylor College of Medicine

Houston

TX

Disclosures

GE declares that he has no competing interests.

Consultant Nephrologist

Nephrology

North Staffs Royal Infirmary

University Hospital of North Staffordshire

Stoke-on-Trent

UK

Disclosures

DdT declares that he has no competing interests.

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