Simplified Approach to Acute Kidney Injury (AKI) 1) IS THIS AN EMERGENCY? Is there a dialysis indication (e.g AEIOU ) or anuria that may require urgent nephrology evaluation? 2) HISTORY/PHYSICAL Assess if patient has common culprits: Hypovolemia, Low effective circulating volume, Urinary obstruction, Nephrotoxic drugs (e.g NSAlDs) 3) FIX THE PROBLEM ~80% of AKI cases are caused by prerenal azotemia or postrenal obstruction: • Trial isotonic fluids (NS or LR) • Obtain post-void residual to assess for obstruction 4) EVALUATE FOR IMPROVEMENT If the urine output and creatinine (in 12-24 hours) has improved, you confirmed diagnosis! If not. go on to step 5... 5) CONSIDER INTRINSIC CAUSES Assess UA w/ microscopy for WBCs, RBCs, casts, crystals, protein. - 80% of intrinsic etiologies due to ATN. • Rx: Time + minimize culprit - Dr. Michael Lorinsky @LorinskyMD #AKI #Acute #KidneyInjury #simplified #workup #diagnosis #nephrology
