Evaluation of acute kidney injury (acute renal failure) among hospitalized patients
- Pedram Fatehi, MD, MPH
Pedram Fatehi, MD, MPH
- Assistant Clinical Professor of Medicine
- Stanford University School of Medicine
- Chi-yuan Hsu, MD, MSc
Chi-yuan Hsu, MD, MSc
- Professor of Medicine
- University of California, San Francisco
Patients with kidney disease have a variety of different clinical presentations. Some have symptoms or signs that are directly related to the kidney (such as gross hematuria) or to reduced renal function (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 the emergency department, in hospitalized patients, or following a procedure.
This topic reviews the evaluation of hospitalized patients who present with AKI. Patients who present to the emergency department with a creatinine above the recent baseline value may be acute or subacute. If recent baseline is not known, the kidney disease may be chronic in nature.
The evaluation of patients who present with subacute kidney injury is discussed elsewhere. (See "Diagnostic approach to the patient with subacute kidney injury in an outpatient setting".)
The evaluation of patients with newly identified chronic kidney disease (CKD) is discussed elsewhere . (See "Diagnostic approach to the patient with newly identified chronic kidney disease".)
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- CLINICAL MANIFESTATIONS
- Major causes and classification of AKI
- Relative frequency of AKI etiologies
- Our approach to evaluation
- - Overview
- - Estimation of glomerular filtration rate
- - Urinalysis
- - Urine sodium excretion
- - Urine volume
- - Serologic testing and role of renal biopsy
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS