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I HAVE A PATIENT WITH ACUTE KIDNEY INJURY

How do I determine the cause?

Constructing and Ranking a DDx

CONSTRUCTING A DIFFERENTIAL DIAGNOSIS

Figure 28-1.

Diagnostic approach: acute kidney injury.

AKI is a broad clinical syndrome defined by an abrupt decrease in kidney function over a period of hours to days, characterized by a rise in serum creatinine or a decrease in urinary output. The time frame of development and persistence of kidney damage defines a spectrum that extends to acute kidney disease (AKD) and chronic kidney disease (CKD). Table 28-1 summarizes the current diagnostic criteria and staging for AKI, AKD, and CKD, which may be relevant in the evaluation and prognostication of disease.

Table 28-1.Diagnostic criteria and staging for kidney disease.

The framework for the differential diagnosis of AKI is a combination of anatomic and pathophysiologic, typically divided into prerenal, intrarenal, and postrenal causes:

  1. Prerenal (due to renal hypoperfusion)

    1. Intravascular ...

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