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Acute Kidney Injury and Elevated Creatinine Referral
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Acute Kidney Injury and Elevated Creatinine Referral
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
Presentation context
Context and timeline
▶
Referral source and reason
Creatinine trend and dates
Baseline creatinine or baseline eGFR if known
Prior outpatient labs within last 7 to 90 days
Known chronic kidney disease stage if applicable
First abnormal value timing relative to illness or exposure
Symptoms and functional impact
Kidney and volume symptoms
▶
Oliguria
Anuria
Polyuria after obstruction relief
Hematuria
Foamy urine
Flank pain
Suprapubic pain
Lower urinary tract symptoms
Edema
Dyspnea
Orthopnea
Confusion
Pruritus
Nausea
Vomiting
Reduced oral intake
Falls
Functional decline
Precipitating events and exposures
AKI triggers
▶
Vomiting
Diarrhea
Fever
Poor intake
Sepsis syndrome symptoms
Recent surgery
Trauma
Heat exposure
Prolonged immobilization
Recent contrast exposure
Recent infection treatment
New rash
New arthralgia
Hemoptysis
Dark urine after exertion
Back pain with neurologic symptoms
Prior episodes and renal trajectory
Baseline trajectory
▶
Prior AKI episodes and triggers
Prior hydronephrosis or stones
Prior glomerulonephritis diagnosis
Prior proteinuria diagnosis
Dialysis history
Transplant history
Alarm Features
Immediate threats
Life threatening patterns
▶
Hypotension with suspected sepsis
Pulmonary edema with hypoxemia
Severe hyperkalemia syndrome
Uremic encephalopathy
Uremic pericarditis
Rapidly progressive glomerulonephritis syndrome
Urinary obstruction with anuria
Hemolysis or thrombotic microangiopathy syndrome
Vital sign thresholds
High risk vitals
▶
Systolic blood pressure less than 90 mmHg
Mean arterial pressure less than 65 mmHg
Heart rate greater than 120
Respiratory rate greater than 30
Oxygen saturation less than 90 percent on room air
Temperature 38.0 C or higher with suspected infection
Emergent nephrology and RRT triggers
Dialysis level emergencies
▶
If potassium 6.0 mmol/L or higher with ECG changes, immediate resuscitation pathway
If refractory potassium 6.5 mmol/L or higher despite temporizing therapy, nephrology and RRT pathway
If severe metabolic acidosis with pH 7.10 or lower or bicarbonate 10 mmol/L or lower with instability, nephrology and RRT pathway
If pulmonary edema with hypoxemia not responding to diuretics and noninvasive support, nephrology and RRT pathway
If uremic pericarditis suspected, nephrology and RRT pathway
If encephalopathy attributed to uremia, nephrology and RRT pathway
If anuria 12 hours or longer or oliguria less than 0.3 mL/kg/hour for 24 hours, urgent nephrology input
If suspected rapidly progressive glomerulonephritis, urgent nephrology input
Medications
Nephrotoxic and hemodynamically active drugs
Medication review focus
▶
NSAIDs
ACE inhibitors
ARBs
Diuretics
SGLT2 inhibitors
Metformin
Lithium
Calcineurin inhibitors
Amphotericin
Aminoglycosides
Vancomycin
Trimethoprim sulfamethoxazole
Proton pump inhibitors
Chemotherapy agents
Contrast exposure adjuncts
Recent changes and adherence
Medication timeline
▶
Recent starts within 14 days
Recent dose increases
Recent dehydration with continued diuretics or RAAS blockade
Missed steroid or immunosuppression doses in transplant
Over the counter analgesic use pattern
Herbal supplements
Diet
Fluid and solute intake
Intake patterns
▶
Low intake days
Excess free water intake
High protein supplements
High potassium foods
High salt intake
Recent fasting
Exposures and toxins
Ingestions and exposures
▶
Alcohol binge with dehydration
Energy drinks with dehydration risk
Suspected ethylene glycol exposure
Suspected methanol exposure
Suspected salicylate exposure
Review of Systems
Renal and genitourinary
GU symptoms
▶
Dysuria
Frequency
Urgency
Hesitancy
Weak stream
Incomplete emptying
Incontinence
Gross hematuria
Flank pain
Suprapubic pain
Systemic and organ clues
System clues
▶
Fever
Rigors
Rash
Arthralgia
Oral ulcers
Sinus symptoms
Hemoptysis
Chest pain
Dyspnea
Abdominal pain
Diarrhea
Myalgias
Dark urine
Headache
Visual symptoms
Neurologic deficits
Collateral History and Family History
Collateral sources
Reliability and baseline
▶
Caregiver report
Facility report
Medication list source
Recent weights and intake
Baseline cognition and function
Family and inherited kidney disease
Family kidney risks
▶
Polycystic kidney disease
Alport syndrome
Early end stage kidney disease
Autoimmune disease history
Thrombotic microangiopathy history
Risk Factors
Patient factors
Comorbid risks
▶
Chronic kidney disease
Diabetes mellitus (E11.9)
Hypertension (I10)
Heart failure (I50.9)
Cirrhosis (K74.60)
Nephrotic syndrome (N04.9)
Malignancy (C80.1)
HIV (B20)
Sickle cell disease (D57.1)
Transplant status (Z94.0)
Pregnancy
Older age
Exposure and setting factors
Exposure risks
▶
Recent contrast imaging
Sepsis risk source
Recent antibiotics
Recent NSAID use
Rhabdomyolysis risk
Obstructive uropathy risk
Recent urinary catheter issues
Systemic autoimmune flare risk
Diarrheal illness with hemolysis risk
Differential Diagnosis
Life threatening
Cannot miss
▶
Sepsis associated AKI (A41.9)
▶
Hypotension
Lactate elevation
Obstructive uropathy with anuria (N13.9)
▶
Suprapubic distension
Hydronephrosis
Rapidly progressive glomerulonephritis (N01.9)
▶
Hematuria
Proteinuria
RBC casts
Thrombotic microangiopathy (D59.3)
▶
Thrombocytopenia
Hemolysis markers
Severe hyperkalemia (E87.5)
▶
ECG changes
Arrhythmia
Acute pulmonary edema from renal failure (J81.0)
▶
Hypoxemia
Pink frothy sputum
Common
Frequent causes
▶
Volume depletion and prerenal azotemia (E86.0)
▶
GI losses
Poor intake
Acute tubular injury from ischemia or toxins (N17.0)
▶
Muddy brown casts
Prolonged hypotension
Drug associated hemodynamic AKI
▶
ACE inhibitor or ARB in renal artery stenosis risk
NSAID with dehydration
Acute interstitial nephritis (N10)
▶
Rash
Eosinophilia
Postrenal obstruction from BPH (N40.1)
▶
Lower urinary tract symptoms
Elevated post void residual
Less common and mimics
Consider with clues
▶
Rhabdomyolysis (M62.82)
▶
CK elevation
Dark urine with minimal RBCs
Hepatorenal syndrome (K76.7)
▶
Advanced cirrhosis
Low urine sodium pattern
Cardiorenal syndrome
▶
Congestion dominant heart failure
BNP elevation
Renal infarction (N28.0)
▶
Sudden flank pain
LDH elevation
Renal vein thrombosis (I82.3)
▶
Nephrotic syndrome
Flank pain
Lab artifact and pseudo elevation
▶
Trimethoprim effect on creatinine secretion
Ketoacidosis assay interference
Past Medical History
Kidney history
Baseline renal status
▶
Known CKD stage
Baseline proteinuria
Prior nephrology follow up
Prior renal imaging abnormalities
Prior kidney biopsy
Prior obstruction history
Comorbid conditions and procedures
Relevant background
▶
Heart failure admissions
Liver disease complications
Autoimmune disease history
Diabetes complications
Vascular disease
Urologic procedures
Indwelling catheter
Stents
Nephrostomy tubes
Physical Exam
General and vitals pattern
Global impression
▶
Toxic appearance
Work of breathing
Mental status changes
Temperature pattern
Blood pressure trend compared with baseline
Volume status
Hemodynamic and congestion exam
▶
Dry mucous membranes
Orthostatic symptoms
Capillary refill delay
Jugular venous distension
Peripheral edema
Lung crackles
Ascites
Weight change trend
Abdomen and genitourinary
Obstruction and infection clues
▶
Suprapubic fullness
CVA tenderness
Bladder distension
Foley catheter patency
Prostate enlargement symptoms correlation
Skin, joints, and vascular
Systemic disease clues
▶
Purpura
Livedo
Rash
Edema distribution
Joint swelling
Digital ischemia
Neurologic and uremic findings
Uremia and complications
▶
Asterixis
Myoclonus
Pericardial rub
Neuropathy symptoms
Seizure activity
Lab Studies
Core blood tests
Initial labs
▶
Creatinine and urea trend
Electrolytes
Potassium
Bicarbonate
Calcium
Phosphate
Magnesium
Glucose
CBC
Venous blood gas if acidosis suspected
Lactate if sepsis suspected
CK if rhabdomyolysis suspected
LFTs if hepatorenal risk
Urine studies
Urine evaluation
▶
Urinalysis
Urine microscopy
Urine albumin creatinine ratio
Urine protein creatinine ratio
Urine sodium
Urine creatinine
Fractional excretion sodium interpretation support
Fractional excretion urea interpretation support
Interpretation thresholds and pitfalls
Key thresholds
▶
Potassium 6.0 mmol/L or higher high risk
Bicarbonate 15 mmol/L or lower high risk
Phosphate elevation with symptomatic hypocalcemia risk
Hemoglobin drop with hemolysis evaluation trigger
Platelets low with thrombotic microangiopathy trigger
Urinalysis heme positive with few RBCs rhabdomyolysis pattern
RBC casts glomerulonephritis pattern
WBC casts interstitial nephritis or pyelonephritis pattern
Granular casts acute tubular injury pattern
Fractional excretion sodium less than 1 percent suggestive prerenal pattern in appropriate context
Fractional excretion urea less than 35 percent suggestive prerenal pattern with diuretic use
FeNa and FeUrea limited in CKD, sepsis, contrast exposure, and diuretic confounding
Imaging
Scoring Systems
Staging and severity tools
▶
KDIGO AKI staging framework
Use for disposition and monitoring intensity
Limitations in low muscle mass and assay variation
MRI
Selected indications
▶
Suspected renal vascular thrombosis when alternative imaging contraindicated
Characterization of renal masses when clinically necessary
Contraindications
▶
Non MRI compatible implants
Hemodynamic instability
CT
Selected indications
▶
Suspected obstructing stone with infection concern
Suspected renal infarction when high suspicion
Contrast caution in AKI
▶
Use only if expected benefit outweighs risk
Local protocol dependent prophylaxis and hydration strategy
Ultrasound
First line for obstruction evaluation
▶
Renal ultrasound for hydronephrosis
Bladder ultrasound or bladder scan for retention
Pitfalls
▶
Early obstruction without hydronephrosis
Hydration status affects collecting system appearance
Special Tests
Bedside evaluation
Point of care assessments
▶
Bladder scan for post void residual
Foley catheter placement if retention suspected and no contraindication
POCUS lungs for pulmonary edema pattern
POCUS IVC for volume status adjunct
Nephrology directed tests
Extended workup triggers
▶
Complement levels with suspected GN
ANCA with suspected vasculitis
Anti GBM with pulmonary renal syndrome
ANA with suspected lupus nephritis
Serum protein electrophoresis with suspected myeloma kidney
Viral serologies when clinically indicated
Renal biopsy consideration in rapidly progressive syndrome
ECG
Indications
When ECG changes management
▶
Potassium 5.5 mmol/L or higher
Any arrhythmia symptoms with AKI
Chest pain or dyspnea with electrolyte derangement risk
Hyperkalemia patterns
High risk findings
▶
Peaked T waves
PR prolongation
QRS widening
Sine wave pattern
Bradyarrhythmias
Ventricular tachyarrhythmias
Assessment
AKI definition and staging
KDIGO definition and stage
▶
Creatinine increase 26.5 micromol/L or more within 48 hours
Creatinine 1.5 times baseline or more within 7 days
Urine output less than 0.5 mL/kg/hour for 6 hours
Stage 1 criteria
▶
Creatinine 1.5 to 1.9 times baseline
Creatinine increase 26.5 micromol/L or more
Urine output less than 0.5 mL/kg/hour for 6 to 12 hours
Stage 2 criteria
▶
Creatinine 2.0 to 2.9 times baseline
Urine output less than 0.5 mL/kg/hour for 12 hours or longer
Stage 3 criteria
▶
Creatinine 3.0 times baseline or more
Creatinine 353.6 micromol/L or higher with acute rise
Urine output less than 0.3 mL/kg/hour for 24 hours or longer
Anuria for 12 hours or longer
Initiation of renal replacement therapy
Etiology framework
Category assignment
▶
Prerenal physiology
Intrinsic renal injury
Postrenal obstruction
Mixed etiology common in older adults
Complications to identify
Consequences
▶
Hyperkalemia (E87.5)
Metabolic acidosis (E87.2)
Volume overload (E87.70)
Uremic symptoms
Drug toxicity accumulation risk
Need for urgent procedures requiring contrast or anesthesia
Plan
First 5 minutes
Immediate stabilization workflow
▶
Cardiac monitor if potassium concern or instability
IV access criteria
▶
Two large bore IVs if shock or severe hyperkalemia
One IV if stable
Oxygen if saturation less than 92 percent
Point of care glucose if altered mental status
If ECG hyperkalemia pattern, initiate temporizing therapy and resuscitation escalation
Diagnostic sequencing
Minimum initial bundle
▶
Repeat creatinine and electrolytes if outpatient abnormal
Urinalysis and microscopy early
Bladder scan early if low urine output or LUTS
Renal ultrasound if obstruction concern or unclear etiology
Sepsis evaluation bundle if infection suspected
Therapeutics
Hemodynamics and kidney protection
▶
If hypovolemia likely, isotonic crystalloid bolus 500 mL to 1000 mL then reassess
If heart failure congestion likely, cautious diuresis strategy
Stop nephrotoxins when possible
▶
NSAIDs
ACE inhibitor
ARB
Metformin if significant AKI or hypoperfusion
Hyperkalemia temporizing therapy when indicated
▶
Calcium gluconate 10 percent 10 mL IV over 2 to 5 minutes if ECG changes
Regular insulin 10 units IV with dextrose 25 g IV
Nebulized salbutamol 10 mg to 20 mg
Sodium bicarbonate 50 mmol IV if severe acidosis and appropriate context
Potassium removal
▶
Loop diuretic if urine output present and volume status allows
Potassium binder if clinically appropriate and local protocol dependent
Suspected urinary obstruction
▶
Foley catheter if retention likely and no contraindication
Urology involvement if difficult catheter or obstructing stone with infection concern
Suspected rapidly progressive glomerulonephritis
▶
Nephrology urgent involvement
Avoid delays for serologies and urine microscopy review
Monitoring and reassessment loop
Reassessment cadence
▶
Repeat vitals within 30 to 60 minutes after fluids or diuresis
Repeat potassium within 1 to 2 hours after temporizing therapy
Strict intake and output
Daily weight if admitted
Repeat creatinine within 6 to 24 hours depending on severity
Consultation and referral logic
Who and when
▶
Nephrology same day for KDIGO stage 2 or 3
Nephrology same day for suspected glomerulonephritis syndrome
Nephrology same day for refractory electrolyte derangements
Urology same day for obstruction with infection concern
ICU consult for shock, severe pulmonary edema, or severe hyperkalemia with instability
Disposition
ICU criteria
Critical care needs
▶
Vasopressor requirement
Respiratory failure
Pulmonary edema requiring high flow or noninvasive ventilation
Refractory hyperkalemia
Severe acidosis with instability
Suspected uremic pericarditis
Inpatient admission criteria
Admission triggers
▶
KDIGO stage 2 or 3 AKI
Anuria or oliguria with rising creatinine
Potassium 5.5 mmol/L or higher with recurrence risk
Bicarbonate 15 mmol/L or lower
Ongoing sepsis or suspected pyelonephritis
Obstruction requiring intervention
Nephritic syndrome
Rhabdomyolysis with CK markedly elevated
Inability to maintain hydration
Unsafe social situation for close follow up
Observation pathway criteria
Possible short stay
▶
KDIGO stage 1 with clear reversible cause
Improving creatinine after initial therapy
Stable potassium below 5.5 mmol/L
Stable volume status and urine output present
Ability to repeat labs within 12 to 24 hours
Discharge criteria and follow up timing
Copy
Discharge requirements
▶
Downtrending creatinine or clear stable baseline
Potassium below 5.0 mmol/L and stable
No pulmonary edema or hypoxemia
No active systemic disease concern
Obstruction excluded when clinically indicated
Reliable follow up within 24 to 72 hours for repeat creatinine and electrolytes
Medication plan adjusted to avoid nephrotoxins
Clear return precautions provided
Discharge Instructions
Copy discharge instructions
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Patient instructions
▶
You were seen for an acute change in kidney function based on your blood test creatinine
Drink fluids as tolerated unless you were told to restrict fluids for heart failure or liver disease
Avoid NSAIDs such as ibuprofen and naproxen until you are told your kidneys have recovered
Take only the medications listed on your updated medication plan
If your clinician told you to hold medications, do not restart them until follow up labs are reviewed
Follow up for repeat blood tests within the time frame provided
Return to the emergency department now for
▶
Trouble breathing
Chest pain
Fainting
Severe weakness
New confusion
No urine output or much less urine than usual
Rapid swelling of legs or face
Persistent vomiting or inability to drink fluids
Fever with worsening flank pain
Palpitations or feeling like you might pass out
References
Guidelines and consensus
KDIGO Clinical Practice Guideline for Acute Kidney Injury 2012
▶
Definition and staging framework
General management principles
KDIGO Acute Kidney Injury and Acute Kidney Disease Guideline update scope of work 2023
▶
Update initiative and intended scope
Local implementation variability
UK Renal Association Clinical Practice Guideline Acute Kidney Injury 2019
▶
Detection and management pathways
Follow up after AKI
Imaging guidance
American College of Radiology Appropriateness Criteria Renal Failure 2021
▶
Imaging to detect obstruction and treatable causes
Modality selection considerations
Key reviews
Khwaja A KDIGO clinical practice guidelines for acute kidney injury 2012
▶
Summary of guideline rationale
Practical interpretation notes
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Acute Kidney Injury and Elevated Creatinine Referral