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Guide to Acute Kidney Injury (AKI)

What to ask/look for: 
 - HPI, PMH, full ROS
CBC w/ diff - Urinalysis ... /microscopy/UOP/ ... weights - Urine ... #Nephrology #Diagnosis ... #Algorithm #Causes
Urinalysis & Urine Sodium 
Theophilus Protospatharius, a seventh-century physician who wrote the first manuscript focused exclusively
Urinalysis & Urine ... Microscopic exam ... • Urinary casts ... Kidney Injury (AKI ... #UNa #casts #glucosuria
Algorithmic Approach to Acute Interstitial Nephritis
When to suspect AIN? (not sensitive)
 • AKI, AKD, rapidly progressive
Algorithmic Approach ... sterile pyuria, WBC casts ... eosinophiluria, microscopic ... proteinuria, granular casts ... #nephrology #diagnosis
Simplified Approach to Acute Kidney Injury (AKI)
1) IS THIS AN EMERGENCY? 
Is there a dialysis indication
cases are caused ... IMPROVEMENT If the urine ... Assess UA w/ microscopy ... for WBCs, RBCs, casts ... #nephrology
Hematuria Workup and Diagnosis Algorithm
 • Confirm hematuria → Urinalysis >3 RBCs/HPF, exclude mimics, repeat testing
Hematuria Workup and Diagnosis ... Algorithm • Confirm ... hematuria → Urinalysis ... proteinuria, RBC casts ... if cause not identified
Urine Microscopy - Casts
Acellular Casts
 • Hyaline Casts - Consists of only precipitated Tamm-Horsfell protein without
Urine Microscopy ... - Casts Acellular ... #Urine #Microscopy ... #nephrology #interpretation ... #diagnosis
Atlas of Urine Microscopy Findings
 • Epithelial cells - Normal
 • Renal tubular cells - Acute
Atlas of Urine Microscopy ... • Red cell casts ... • White cell casts ... disease • Granular casts ... #nephrology #casts
Hematuria - Differential Diagnosis Framework

Gross Hematuria: Red/Dark urine
 • 1ml blood/liter urine can induce color change
- Differential Diagnosis ... (Urinalysis or ... hematuria: - RBC casts ... → Diagnostic of ... #nephrology #renal
Causes of Acute Kidney Injury (AKI) - Differential Diagnosis Algorithm
Acute Kidney Injury (AKI) - Acute increase
Causes of Acute ... Epithelial cell casts ... polyangiitis /microscopic ... #KidneyInjury #Nephrology ... #Algorithm #Causes
Urine Microscopy Instructions - How to spin urine

1. Collect a fresh urine sample (5 – 10
Urine Microscopy ... the better, as casts ... perform a quick urinalysis ... #Urine #Microscopy ... #Nephrology #Preparation