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Diagnostic approach to the patient with subacute kidney injury in an outpatient setting

Authors
Pedram Fatehi, MD, MPH
Chi-yuan Hsu, MD, MSc
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Patients with kidney disease may have a variety of different clinical presentations. Some have symptoms or signs that are directly referable to the kidney (such as 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 generally cause acute, subacute, or chronic kidney injury. Acute kidney injury (AKI) develops over hours to days and is usually diagnosed in hospitalized patients or following a procedure. Subacute kidney injury defines a presentation that develops more slowly than AKI but generally results in an increased creatinine in less than three months. Chronic kidney disease (CKD) is defined by an elevated creatinine, or other evidence of kidney damage, that is relatively stable for greater than three months.

Although not all presentations fit within these narrowly defined categories, knowledge of the duration and acuity of onset of disease often narrows the differential diagnosis among patients who may present similar clinical findings related to the kidney.

This topic reviews the evaluation of patients who present with subacute kidney injury [1]. Most patients are evaluated as outpatients. The evaluation of patients (generally hospitalized patients) who develop an increase in creatinine within hours to days is discussed elsewhere [1]. (See "Evaluation of acute kidney injury (acute renal failure) among hospitalized patients".)

The evaluation of patients with newly identified CKD is discussed elsewhere [1]. (See "Diagnostic approach to the patient with newly identified chronic kidney disease".)

                  

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Literature review current through: Apr 2016. | This topic last updated: Mar 14, 2016.
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References
Top
  1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 2:1.
  2. Harper L, Savage CO. ANCA-associated renal vasculitis at the end of the twentieth century--a disease of older patients. Rheumatology (Oxford) 2005; 44:495.
  3. Hedger N, Stevens J, Drey N, et al. Incidence and outcome of pauci-immune rapidly progressive glomerulonephritis in Wessex, UK: a 10-year retrospective study. Nephrol Dial Transplant 2000; 15:1593.
  4. Rose BD. Pathophysiology of Renal Disease, 2nd ed., McGraw-Hill, New York 1987. p.41.
  5. Moghazi S, Jones E, Schroepple J, et al. Correlation of renal histopathology with sonographic findings. Kidney Int 2005; 67:1515.
  6. Manley JA, O'Neill WC. How echogenic is echogenic? Quantitative acoustics of the renal cortex. Am J Kidney Dis 2001; 37:706.
  7. Platt JF, Rubin JM, Bowerman RA, Marn CS. The inability to detect kidney disease on the basis of echogenicity. AJR Am J Roentgenol 1988; 151:317.
  8. Kitamoto Y, Tomita M, Akamine M, et al. Differentiation of hematuria using a uniquely shaped red cell. Nephron 1993; 64:32.
  9. Köhler H, Wandel E, Brunck B. Acanthocyturia--a characteristic marker for glomerular bleeding. Kidney Int 1991; 40:115.
  10. Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med 2002; 137:744.
  11. Holding S, Spradbery D, Hoole R, et al. Use of serum free light chain analysis and urine protein electrophoresis for detection of monoclonal gammopathies. Clin Chem Lab Med 2011; 49:83.
  12. Katzmann JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev 2009; 30:105.
  13. Madaio MP. Renal biopsy. Kidney Int 1990; 38:529.
  14. Appel GB. Renal biopsy: How effective, what technique, and how safe. J Nephrol 1993; 6:4.