Diagnostic approach to the patient with acute kidney injury (acute renal failure) or chronic kidney disease
- Pedram Fatehi, MD, MPH
Pedram Fatehi, MD, MPH
- Assistant Clinical Professor of Medicine
- University of California, San Francisco
- Chi-yuan Hsu, MD, MSc
Chi-yuan Hsu, MD, MSc
- Professor of Medicine
- University of California, San Francisco
Patients with kidney disease may have a variety of different clinical presentations. Some have symptoms or signs that are directly referable to the kidney (gross hematuria) or to associated extrarenal manifestations (edema, hypertension, signs of uremia). Many patients are asymptomatic and are incidentally found to have an elevated serum creatinine concentration, abnormal urine studies (such as proteinuria or microscopic hematuria), or abnormal radiologic imaging of the kidneys. Specific disorders are more likely to be either acute or chronic in duration, thereby narrowing the differential diagnosis among patients presenting with similar clinical findings related to the kidney.
An overview of the diagnostic approach to the patient with kidney disease is presented in this topic review. The major components to this approach are:
●Careful history taking and physical examination
●Assessment of renal function by estimation of the glomerular filtration rate (GFR) (see 'Evaluation' below)
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- Disease duration
- MAJOR CAUSES AND CLASSIFICATION OF KIDNEY DISEASE
- Prerenal disease
- Intrinsic renal vascular disease
- Intrinsic glomerular disease
- Intrinsic tubular and interstitial disease
- Obstructive nephropathy
- Relative frequency of acute kidney injury etiologies
- Relative frequency of chronic kidney disease etiologies
- Relationship between acute kidney inury and chronic kidney disease
- PRESENTING MANIFESTATIONS
- In-hospital acute kidney injury
- Diagnosis of underlying cause
- Estimation of glomerular filtration rate
- URINARY FINDINGS
- Urine sodium excretion
- - Acute kidney injury
- - Chronic kidney disease
- Urine volume
- RADIOLOGIC STUDIES
- SEROLOGIC TESTING AND ROLE OF RENAL BIOPSY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS