Diagnostic Approach to Patients with Suspected Acute Kidney Injury (AKI) - Flowchart

Diagnostic Approach to Patients with Suspected Acute Kidney Injury (AKI) - Flowchart

Diagnostic Approach to Patients with Suspected Acute Kidney Injury (AKI) - Flowchart Acute Kidney injury Acute Kidney injury

«Flowchart»

Acute kidney injury

Acute kidney injury

Acute kidney injury

Acute kidney injury

Recovery AKI

Recovery AKI

Recovery AKI

Furosemide
Mannitol

Furosemide
Mannitol

Furosemide
Mannitol

Fluid repletion

Fluid repletion

Fluid repletion

Increased urine volume

Increased urine volume

Increased urine volume

Oliguria

Oliguria

Oliguria

End

End

End

Nonoliguric AKI

Nonoliguric AKI

Nonoliguric AKI

Conservative therapy
Dialysis
Nutritional support (K⁺ and fluid restriction)

Conservative therapy
Dialysis
Nutritional support (K⁺ and fluid restriction)

Conservative therapy
Dialysis
Nutritional support (K⁺ and fluid restriction)

⁺

Recovery AKI

Recovery AKI

Recovery AKI

>3 weeks

>3 weeks

>3 weeks

Renal biopsy

Renal biopsy

Renal biopsy

Tubular cell cylinders

Tubular cell cylinders

Tubular cell cylinders

Fluid administration

Fluid administration

Fluid administration

Red or white blood cell casts
Blood or serologic abnormalities

Red or white blood cell casts
Blood or serologic abnormalities

Red or white blood cell casts

Clinical diagnosis
Renal biopsy?

Clinical diagnosis
Renal biopsy?

Clinical diagnosis
Renal biopsy?

Vasculitis

Vasculitis

Vasculitis

AGN

AGN

AGN

HUS/TTP

HUS/TTP

HUS/TTP

AIN

AIN

AIN

Tubular cell cylinders

Tubular cell cylinders

Tubular cell cylinders

Fluid administration

Fluid administration

Fluid administration

Red or white blood cell casts
Blood or serologic abnormalities

Red or white blood cell casts
Blood or serologic abnormalities

Red or white blood cell casts

No ureteral, renal pelvic dilation

No ureteral, renal pelvic dilation

No ureteral

Suspicion retroperitoneal pathology

Suspicion retroperitoneal pathology

Suspicion retroperitoneal pathology

CT scan

CT scan

CT scan

Relief of obstruction

Relief of obstruction

Relief of obstruction

Recovery AKI

Recovery AKI

Recovery AKI

Bladder catheter

Bladder catheter

Bladder catheter

Yes

Yes

Yes

No

No

No

Increased urinary volume

Increased urinary volume

Increased urinary volume

Recovery AKI

Recovery AKI

Recovery AKI

CT scan
Retrograde pyelography

CT scan
Retrograde pyelography

CT scan
Retrograde pyelography

Suspicion retroperitoneal pathology

Suspicion retroperitoneal pathology

Suspicion retroperitoneal pathology

No ureteral, renal pelvic dilation

No ureteral, renal pelvic dilation

No ureteral

Ureteral, renal pelvic dilation

Ureteral, renal pelvic dilation

Ureteral

CT scan

CT scan

CT scan

Increased urine volume

Increased urine volume

Increased urine volume

Oliguria

Oliguria

Oliguria

Recovery AKI

Recovery AKI

Recovery AKI

Persistent AKI

Persistent AKI

Persistent AKI

Increased urine volume

Increased urine volume

Increased urine volume

Oliguric AKI

Oliguric AKI

Oliguric AKI

Clinical suspicion vascular obstruction

Clinical suspicion vascular obstruction

Clinical suspicion vascular obstruction

Intrarenal AKI

Intrarenal AKI

Intrarenal AKI

Doppler ultrasound
Angiography

Doppler ultrasound
Angiography

Doppler ultrasound
Angiography

Negative

Negative

Negative

Thrombosis

Thrombosis

Thrombosis

Prerenal AKI

Prerenal AKI

Prerenal AKI

Prerenal AKI

Intrarenal AKI

Intrarenal AKI

Intrarenal AKI

Intrarenal AKI

Postrenal AKI

Postrenal AKI

Postrenal AKI

Postrenal AKI

History and record review, physical examination, blood and urine analysis, ultrasound

History and record review, physical examination, blood and urine analysis, ultrasound

History and record review, physical examination, blood and urine analysis, ultrasound

Normal urinary sediment, no hematuria or proteinuria FE_Na <1%, FE_urea <35%

Normal urinary sediment, no hematuria or proteinuria FE_Na <1%, FE_urea <35%

_Na _urea Normal urinary sediment

Exog. nephrotoxin exposure, rhabdomyolysis, hemolysis

Exog. nephrotoxin exposure, rhabdomyolysis, hemolysis

Exog. nephrotoxin exposure

Edema, hypertension, abnormal urinary sediment, proteinuria

Edema, hypertension, abnormal urinary sediment, proteinuria

Edema

Bladder distention?

Bladder distention?

Bladder distention?

Thrombectomy or fibrinolytic therapy

Thrombectomy or fibrinolytic therapy

Thrombectomy or fibrinolytic therapy

Persistent AKI

Persistent AKI

Persistent AKI

Recovery AKI

Recovery AKI

Recovery AKI

Nonoliguric AKI

Nonoliguric AKI

Nonoliguric AKI

Oliguric AKI

Oliguric AKI

Oliguric AKI

Persistent AKI

Persistent AKI

Persistent AKI

Recovery AKI

Recovery AKI

Recovery AKI

Treatment

Treatment

Treatment

Persistent AKI

Persistent AKI

Persistent AKI

Recovery AKI

Recovery AKI

Recovery AKI