History and exam
Key diagnostic factors
common
reduced urine production
Oliguria and anuria are common in AKI. They are not suggestive of a particular etiology.
vomiting
May precede AKI and suggest prerenal azotemia, or be a later manifestation resulting from uremia.
dizziness
Orthostatic symptoms support prerenal azotemia.
orthopnea
Symptoms of volume overload may result from impaired salt and volume regulation and decreased urine production.
paroxysmal nocturnal dyspnea
Symptoms of volume overload may result from impaired salt and volume regulation and decreased urine production. Congestive heart failure increases risk for prerenal azotemia.
pulmonary edema
Evidence of pulmonary edema (e.g., rales on exam) suggest volume overload resulting from impaired salt and volume regulation.
hypotension
Supports prerenal azotemia that may progress to acute tubular necrosis.
tachycardia
Supports prerenal azotemia.
orthostatic hypotension
Orthostatic symptoms support prerenal azotemia.
hypertension
Suggests intravascular volume expansion.
peripheral edema
May result from impaired renal salt excretion.
uncommon
muscle tenderness
Suspect rhabdomyolysis and pigment-induced AKI.
limb ischemia
Suspect rhabdomyolysis and pigment-induced AKI.
seizures
Suspect rhabdomyolysis and pigment-induced AKI.
prostatic obstructive symptoms
Postrenal failure can occur in older men with prostatic obstruction and symptoms of urgency, frequency, or hesitancy.
hematuria
May indicate obstruction caused by renal calculi, papillary necrosis, infection, tumor, or acute glomerulonephritis.
fever
If present, suspect interstitial nephritis, systemic disease, infectious complication, or vasculitis.
rash
If present, suspect interstitial nephritis, systemic disease, infectious complication, or vasculitis.
arthralgia/arthritis
If present, suspect interstitial nephritis, systemic disease, infectious complication, or vasculitis.
altered mental status
May be due to underlying illness; will also be seen in AKI when uremia ensues.
signs of uremia
Although more often seen in chronic renal failure, symptoms and signs may be seen in AKI prior to dialysis initiation (e.g., asterixis, pericardial rub).
Other diagnostic factors
common
nausea
May precede AKI and suggest prerenal azotemia, or be a later manifestation resulting from uremia.
uncommon
thirst
Suggests prerenal azotemia if normal physiologic responses and drives are present in a conscious patient.
flank pain
May indicate infection, obstruction caused by renal calculi, or papillary necrosis.
abdominal distention
Bladder outlet obstruction may manifest as distention and pain. Severe intra-abdominal pressure can lead to abdominal compartment syndrome.
abdominal bruit
Presence of renal bruits suggests renovascular disease.
livedo reticularis
The presence of classic findings for systemic diseases may suggest renal manifestations.
petechiae
The presence of classic findings for systemic diseases may suggest renal manifestations.
ecchymoses
The presence of classic findings for systemic diseases may suggest renal manifestations.
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