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Diagnostic approach to the patient with acute kidney injury (acute renal failure) or chronic kidney disease

Pedram Fatehi, MD, MPH
Chi-yuan Hsu, MD, MSc
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD


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)

Careful examination of the urine (by both qualitative chemical tests and microscopic examination) since the urinary findings narrow the differential (table 1) (see 'Urinary findings' below)


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Literature review current through: Oct 2015. | This topic last updated: Mar 5, 2015.
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