EVALUATION OF AZOTEMIA
AZOTEMIA

Urinalysis and Renal ultrasound

Renal size parenchyma
Urinalysis

Chronic Renal Failure

Symptomatic treatment delay progression
If end-stage, prepare for dialysis

Prerenal Azotemia

Volume contraction, cardiac failure, vasodilatation, drugs, sepsis, renal vasoconstriction, impaired autoregulation

Acute Tubular Necrosis

Urologic evaluation
Relieve obstruction

Renal biopsy

Glomerulonephritis or vasculitis

Immune complex, anti-GBM disease

Renal artery or vein occlusion

Angiogram

Interstitial nephritis

Pyelonephritis

End

Small kidneys, thin cortex, bland sediment, isosthenuria <3.5 g protein/24 h

Normal size kidneys
Intact parenchyma

Muddy brown casts, amorphous sediment + protein

RBC casts
Proteinuria

Red blood cells

WBC, casts eosinophils

Bacteria

Urine electrolytes

FeNa <1% U osmolality >500 mosmol

FeNa >1% U osmolality <350 mosmol

FeNa >1% U osmolality <350 mosmol

Hydronephrosis

Acute Renal Failure

Normal urinalysis with oliguria

Abnormal urinalysis

Bacteria

Interstitial nephritis

RBC

RBC casts protienuria

Renal