Last reviewed: 25 Oct 2020
Last updated: 29 Sep 2020

Summary

Definition

History and exam

Key diagnostic factors

  • oliguria or anuria
  • hypotension
  • tachycardia

Other diagnostic factors

  • poor oral intake and anorexia
  • malaise
  • thirst
  • dizziness
  • orthopnea/dyspnea
  • edema

Risk factors

  • chronic kidney disease (CKD)
  • chronic hypertension
  • diabetes mellitus
  • advanced age
  • low-perfusion states
  • sepsis
  • major surgery
  • exposure to nephrotoxic agents
  • exposure to radiocontrast media
  • exposure to endogenous toxins

Diagnostic investigations

1st investigations to order

  • basic metabolic profile (including BUN and creatinine)
  • BUN-to-creatinine ratio
  • urine sodium concentration
  • urine osmolality
  • fractional excretion of sodium
  • fractional excretion of BUN
  • urinalysis for sediment
  • CBC
  • coagulation studies
  • urinary myoglobin
More 1st investigations to order

Investigations to consider

  • arterial blood gases (ABG)
  • platelet aggregation studies
  • ultrasound
  • ECG
  • inferior vena cava (IVC) diameter measured by ultrasound
  • renal biopsy
  • serum and urinary biomarkers
More investigations to consider

Treatment algorithm

Contributors

Consulting Staff

Nephrology Department

FundaciĆ³ Puigvert

Barcelona

Spain

Disclosures

MJLC declares that she has no competing interests.

Resident

Nephrology Department

FundaciĆ³ Puigvert

Barcelona

Spain

Disclosures

LFA declares that she has no competing interests.

Dr Maria Jesus Lloret Cora would like to gratefully acknowledge Dr Roser Torra, the previous contributor to this topic.

Disclosures

RT declares that she has no competing interests.

Peer reviewersVIEW ALL

Medical Director

Blood Management

Cleveland Clinic

Cleveland

OH

Disclosures

AK has received a fee for speaking about perioperative blood management from Ortho-Biotech and has also received reimbursement from medscape.com for the education webcast of the same presentation.

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Disclosures

IM declares that he has no competing interests.

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Disclosures

RT declares that he has no competing interests.

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