Abrupt decline in kidney function — KDIGO ≥0.3 mg/dL Cr rise in 48 h, ≥1.5× baseline in 7 d, or oliguria.
Causes
- • Pre-renal: hypovolaemia, sepsis, HF, NSAID/ACEi
- • Renal: ATN, GN, interstitial nephritis, contrast
- • Post-renal: obstruction
Investigations
- • U&E, urinalysis (blood, protein, casts)
- • USS renal tract (urgent if obstruction)
- • FENa, urine Na, osmolality
- • Bloods: FBC, CK, immunology if intrinsic
Management
- • Stop nephrotoxins (NSAID, ACEi/ARB, gent)
- • Optimise volume + perfusion
- • Relieve obstruction (catheter, nephrostomy)
- • Treat cause; RRT if AEIOU criteria
Complications
- • Hyperkalaemia, acidosis, fluid overload
- • CKD progression
Clinical pearls
- • AEIOU for dialysis: Acidosis, Electrolytes (K), Intoxication, Overload, Uraemia
- • Urine output is the cheapest monitoring tool
Educational — verify locally.
