Approach to the Pt with Azotemia - Flowchart
Approach to the Pt with Azotemia - Flowchart
«Flowchart»

EVALUATION OF AZOTEMIA

AZOTEMIA

EVALUATION OF AZOTEMIA

AZOTEMIA

EVALUATION OF AZOTEMIA

EVALUATION OF AZOTEMIA

AZOTEMIA

AZOTEMIA

Urinalysis and renal ultrasound

Urinalysis and renal ultrasound

Urinalysis and renal ultrasound

Renal size parenchyma
Urinalysis

Renal size parenchyma
Urinalysis

Renal size parenchyma
Urinalysis


Chronic Renal Failure


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

Chronic Renal Failure


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

Chronic Renal Failure

Chronic Renal Failure


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


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

Prerenal Azotemia


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

Prerenal Azotemia


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

Prerenal Azotemia

Prerenal Azotemia


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


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

Acute Tubular Necrosis

Acute Tubular Necrosis

Acute Tubular Necrosis

Acute Tubular Necrosis

Urologic evaluation
Relieve obstruction

Urologic evaluation
Relieve obstruction

Urologic evaluation
Relieve obstruction


Renal biopsy

Renal biopsy

Renal biopsy

Glomerulonephritis or vasculitis


Immune complex, anti-GBM disease

Glomerulonephritis or vasculitis


Immune complex, anti-GBM disease

Glomerulonephritis or vasculitis

Glomerulonephritis or vasculitis


Immune complex, anti-GBM disease


Immune complex, anti-GBM disease

Angiogram

Angiogram

Angiogram

Pyelonephritis

Pyelonephritis

Pyelonephritis

Pyelonephritis

End

End

End

Urine electrolytes

Urine electrolytes

Urine electrolytes

FeNa <1% U osmolality >500 mosmol

FeNa <1% U osmolality >500 mosmol

FeNa <1%

FeNa >1% U osmolality <350 mosmol

FeNa >1% U osmolality <350 mosmol

FeNa >1%

FeNa >1% U osmolality <350 mosmol

FeNa >1% U osmolality <350 mosmol

FeNa >1% U osmolality <350 mosmol

Acute Renal Failure

Acute Renal Failure

Acute Renal Failure

Acute Renal Failure

Normal urinalysis with oliguria

Normal urinalysis with oliguria

Normal

Abnormal urinalysis

Abnormal urinalysis

Abnormal

FeNa, fractional excretion of sodium; GBM, glomerular basement membrane.

FeNa, fractional excretion of sodium; GBM, glomerular basement membrane.

FeNa, fractional excretion of sodium; GBM, glomerular basement membrane.

Hydronephrosis

Hydronephrosis

Hydronephrosis

Hydronephrosis

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

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

Small kidneys

Normal size kidneys
Intact parenchyma

Normal size kidneys
Intact parenchyma


Normal size kidneys

Muddy brown casts, amorphous sediment + protein

Muddy brown casts, amorphous sediment + protein

Muddy brown casts

RBC casts
Proteinuria

RBC casts
Proteinuria


RBC casts

RBCs

RBCs

RBCs

WBC casts, eosinophils

WBC casts, eosinophils

WBC casts

Bacteria

Bacteria

Bacteria

RBC casts protienuria

RBC casts protienuria

RBC casts

Renal artery or vein occlusion

Renal artery or vein occlusion

Renal artery or vein occlusion Renal artery

Bacteria

Bacteria

Bacteria

Interstitial nephritis

Interstitial nephritis

Interstitial nephritis Interstitial nephritis