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Oliguria and AnuriaAPPROACH

RENAL AND URINARY · 19 SECTIONS

⚲

639 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Oliguria And Anuria Catheter Related Urinary Complaints Dialysis Patient Presentations Flank Pain And Renal Colic Concern Urinary Retention Hematuria Scrotal Pain

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx76

Urine output pattern

›Urine output characterization

›Oliguria definition

›Adult urine output < 0.5 mL/kg/hour for 6 hours

›Anuria definition

›Adult urine output < 50 mL/day

›Time course

›Sudden onset hours

›Progressive days

›Baseline renal function and urine output

›Prior creatinine trend

›Chronic kidney disease history

OPQRST

›Symptom anchors for associated complaints

›Onset

›Last normal void time

›Abrupt after procedure or trauma

›Provocation/Palliation

›Worse with dehydration

›Relief after catheterization

›Quality

›Suprapubic pressure

›Flank colic pain

›Region/Radiation

›Flank

›Groin radiation

›Severity

›Pain score

02Alarm Features/alarm35

Immediate threats

›Resuscitation triggers

›Shock physiology

›SBP < 90 mmHg

›MAP < 65 mmHg

›Lactate elevation

›Severe hyperkalemia concern

›K 6.5 mmol/L or higher

›ECG changes with elevated K

›Pulmonary edema

›Hypoxemia

›Respiratory distress

›Uremic emergencies

›Encephalopathy

›Pericarditis

›Uncontrolled bleeding

Obstruction red flags

›High risk obstruction features

›Anuria with bladder distension

›Suprapubic pain

›Palpable bladder

›Solitary kidney

›Known nephrectomy

›Transplant kidney

›Bilateral obstruction risk

›Known bilateral stones

›Pelvic malignancy

03Medications/meds45

Nephrotoxic and hemodynamic agents

›Medication exposures

›NSAIDs

›Recent start

›High dose use

›ACE inhibitors

›Recent dose change

›Suspected renal artery stenosis risk

›ARBs

›Recent dose change

›Volume depletion context

›Diuretics

›Overdiuresis risk

›Recent escalation

›Aminoglycosides

›Gentamicin

›Tobramycin

›Vancomycin

›High trough exposure

›Concomitant piperacillin tazobactam exposure

›Calcineurin inhibitors

›Tacrolimus

›Cyclosporine

›Chemotherapy

›Cisplatin

›Ifosfamide

Allergic interstitial nephritis triggers

›Hypersensitivity linked drugs

04Diet/diet13

Intake and hydration

›Recent intake pattern

›Poor oral intake

›Nausea

›Inability to drink

›Excessive losses

›Diarrhea

›Vomiting

›High protein intake

›Catabolic state

›Supplement use

›High potassium intake context

›Salt substitutes

›Large fruit juice intake

05Review of Systems/ros21

System checklist

›Organ system symptoms

›Constitutional

›Fever

›Weight loss

›Cardiopulmonary

›Chest pain

›Dyspnea

›Orthopnea

›GI

›Vomiting

›Diarrhea

›GU

›Dysuria

›Hematuria

›Flank pain

›Neuro

›Confusion

›Seizure

›Skin and MSK

›Rash

›Myalgias

06Collateral History and Family History/chafh10

Collateral and inherited risk

›Additional sources and inherited conditions

›Collateral source reliability

›Caregiver report

›Medication list verification

›Family renal disease

›Polycystic kidney disease (Q61.2)

›Alport syndrome

›Early cardiovascular disease

›MI or stroke before age 55 male relative

›MI or stroke before age 65 female relative

07Risk Factors/rf26

AKI susceptibility and exposures

›Risk profile

›Chronic kidney disease (N18.9)

›Baseline eGFR reduction

›Proteinuria history

›Diabetes mellitus (E11.9)

›Microvascular disease

›Diabetic nephropathy history

›Heart failure (I50.9)

›Cardiorenal physiology risk

›Diuretic dependence

›Cirrhosis (K74.60)

›Ascites

›Hepatorenal syndrome risk

›Sepsis or severe infection

›Recent bacteremia

›ICU stay

›Obstructive uropathy risk

›BPH (N40.1)

›Pelvic malignancy history

›Neurogenic bladder (N31.9)

›Vascular risk

›Atherosclerosis

›Known renal artery stenosis

›Pregnancy related risk

›Preeclampsia (O14.9)

›HELLP syndrome

08Differential Diagnosis/ddx49

Life threatening

›Immediate risk diagnoses

›Hyperkalemia with malignant arrhythmia

›Bradycardia

›Ventricular tachyarrhythmia

›Urosepsis with obstructive uropathy

›Fever with flank pain

›Hypotension

›Bilateral ureteral obstruction

›Anuria

›Hydronephrosis

›Acute glomerulonephritis with pulmonary renal syndrome

›Hemoptysis

›Rapid creatinine rise

›Thrombotic microangiopathy

›Hemolysis

›Thrombocytopenia

›Acute renal infarction

›Sudden flank pain

›LDH elevation

Common

›Common causes by category

›Prerenal azotemia

›Hypovolemia

›Low effective arterial blood volume

›Acute tubular injury or necrosis (N17.0)

›Sepsis associated

›Ischemic hypotension

09Past Medical History/pmh16

Baseline renal and urologic history

›Relevant prior conditions

›Chronic kidney disease stage

›Prior eGFR baseline

›Dialysis history

›Prior urinary retention episodes

›Catheterization history

›Known BPH

›Urolithiasis history

›Prior obstructing stone

›Prior stent placement

›Renal transplant history (Z94.0)

›Immunosuppression regimen

›Prior rejection episodes

›Recent hospitalization

›Sepsis

›Contrast studies

10Physical Exam/exam36

Vitals and general

›Global assessment

›Vital sign patterns

›Hypotension

›Fever

›Tachycardia

›Volume status

›Dry mucous membranes

›Orthostatic changes

›Capillary refill delay

›Fluid overload

›Elevated JVP

›Crackles

›Peripheral edema

Focused abdominal and GU

›Abdominal and GU findings

›Bladder distension

›Suprapubic fullness

›Suprapubic tenderness

›Costovertebral angle tenderness

›Unilateral

›Bilateral

›Genital exam when relevant

›Phimosis

›Paraphimosis

›Rectal exam when indicated

›Prostate enlargement

›Prostate tenderness

11Lab Studies/labs46

Core AKI panel

›Initial labs

›BMP

›Creatinine trend

›Potassium

›Bicarbonate

›CBC

›Leukocytosis

›Anemia

›Venous blood gas

›pH

›Lactate

›Urinalysis with microscopy

›Hematuria

›Proteinuria

›Casts

›Urine culture when infection possible

›Pyuria

›Nitrites

Urine indices and interpretation

›Urine chemistry patterns

›Urine sodium

›Low urine sodium supportive of prerenal states

›Limitations in diuretic use

›FENa

›< 1 percent supportive of prerenal physiology

›Unreliable with diuretics

›FEUrea

12Imaging/img44

Scoring Systems

›AKI staging and urine output criteria

›KDIGO AKI stage

›Stage 1

›Creatinine 1.5 to 1.9 times baseline or 0.3 mg/dL increase

›Urine output < 0.5 mL/kg/hour for 6 to 12 hours

›Stage 2

›Creatinine 2.0 to 2.9 times baseline

›Urine output < 0.5 mL/kg/hour for 12 hours or longer

›Stage 3

›Creatinine 3.0 times baseline

›Creatinine 4.0 mg/dL or higher

›Dialysis initiation

›Urine output < 0.3 mL/kg/hour for 24 hours or longer

›Anuria for 12 hours or longer

›Limitations

›Creatinine lag in early AKI

›Baseline creatinine uncertainty

MRI

›MRI applications

›Renal artery imaging

›MRA when CTA contraindicated

›Gadolinium risk in advanced CKD

›Renal mass evaluation

›Indeterminate lesion characterization

›Contrast avoidance considerations

›CT pathways

13Special Tests/spec13

Bedside diagnostics and procedures

›Bedside tests

›Bladder scan

›High post void residual supportive of retention

›Guides catheterization

›Foley catheterization

›Immediate urine return supportive of outlet obstruction

›Monitor post obstructive diuresis risk

›Urine microscopy interpretation

›Muddy brown casts supportive of acute tubular injury

›RBC casts supportive of glomerulonephritis

›Fluid challenge response

›Small bolus strategy when not overloaded

›Lack of response suggests intrinsic or obstructive etiologies

14ECG/ecg12

Hyperkalemia and uremic complications

›ECG priorities

›Hyperkalemia patterns

›Peaked T waves

›PR prolongation

›QRS widening

›Sine wave risk

›Arrhythmias

›Bradycardia

›Ventricular tachycardia

›Uremic pericarditis clues

›Diffuse ST elevation possibility

›Clinical correlation required

15Assessment/ax16

Categorize AKI and urgent complications

›Working problem list

›Oliguria or anuria with suspected AKI (N17.9)

›Prerenal

›Intrinsic renal

›Postrenal

›Severity stratification

›KDIGO stage based on creatinine and urine output

›Rate of rise of creatinine

›Immediate complications to rule out

›Hyperkalemia

›Severe metabolic acidosis

›Pulmonary edema

›Obstructed infected system

›Diagnostic uncertainty flags

›Unknown baseline creatinine

›Mixed prerenal and intrinsic physiology

16Plan/plan90

Differential Management

›!Acute Kidney Injury (Pre-renal)→›!Acute Kidney Injury (ATN)→›Acute Kidney Injury (Post-renal)→›Urinary Retention→

First 5 minutes

›Time critical actions

›Monitoring and access

›Cardiac monitor if K elevation suspected

›IV access

›Immediate point of care checks

›Fingerstick glucose if altered

›ECG if K elevation suspected

›Rapid obstruction screen

›Bladder scan

›Foley catheter if retention likely

›Severe hyperkalemia treatment if present

›Calcium gluconate IV 1 g

›Repeat dose if ECG changes persist after 5 to 10 minutes

›Insulin regular IV 10 units with dextrose

›Dextrose 25 g IV if glucose < 14 mmol/L

›Nebulized albuterol 10 to 20 mg

›Sodium bicarbonate IV if severe acidosis

›Dialysis activation for refractory hyperkalemia

Diagnostic sequencing

›Initial diagnostic path

›Labs

›BMP for K and bicarbonate

›Urinalysis with microscopy

›Infection evaluation when indicated

›Blood cultures

›Lactate

›Imaging for obstruction

›Bedside bladder scan then Foley

›Renal ultrasound if anuria or persistent oliguria

Fluids and hemodynamics

›Volume and perfusion management

›Hypovolemia without overload

›Isotonic crystalloid 500 mL bolus

›Reassess after each bolus

›Heart failure or pulmonary edema

›Avoid empiric fluids

›Noninvasive ventilation if needed

›Shock or sepsis

›Local protocol dependent resuscitation volumes

›Early vasopressor if fluid nonresponsive

Treat reversible causes

›Etiology directed actions

›Postrenal

›Foley for suspected outlet obstruction

›Urology consult for failed catheterization

›Nephrostomy consideration for upper tract obstruction

›Suspected pyelonephritis with obstruction

›Broad spectrum antibiotics

›Urgent decompression pathway

›Medication related AKI

›Stop NSAIDs

›Hold ACE inhibitor and ARB during AKI

›Review nephrotoxin combinations

›Suspected glomerulonephritis

›Nephrology consult

›Avoid delay in workup when pulmonary hemorrhage concern

›Rhabdomyolysis

›Isotonic crystalloid infusion

›CK trend monitoring

Reassessment loop

›Time based reevaluation

›Urine output monitoring

›Hourly in severe AKI

›Foley output measurement

›Repeat labs

›Potassium recheck within 1 to 2 hours if treated

›Creatinine and bicarbonate within 4 to 6 hours if unstable

›Fluid balance and respiratory status

›Lung findings

›Oxygen requirement changes

›Post obstructive diuresis monitoring

›Urine output > 200 mL/hour for 2 hours

›Electrolyte monitoring frequency escalation

Renal replacement therapy triggers

›Dialysis indications

›Refractory hyperkalemia

›Persistent K 6.5 mmol/L or higher

›Ongoing ECG changes

›Refractory pulmonary edema

›Hypoxemia despite therapy

›Volume overload not diuretic responsive

›Severe metabolic acidosis

›pH < 7.1 with clinical deterioration

›Refractory to temporizing therapy

›Uremic complications

›Pericarditis

›Encephalopathy

›Bleeding with suspected uremic platelet dysfunction

›Toxin ingestion

›Local protocol dependent dialyzable toxins

›Poison control guidance

17Disposition/dispo40

Level of care criteria

›ICU or monitored bed

›Severe hyperkalemia treated or ongoing risk

›ECG changes

›K 6.0 mmol/L or higher with AKI

›Respiratory failure or pulmonary edema

›Noninvasive ventilation

›Rising oxygen needs

›Shock or sepsis

›Vasopressors

›Lactate elevation with instability

›Dialysis initiation or imminent need

›AEIOU indications present

›Rapidly rising K or acidosis

Admission and observation

›Inpatient admission

›New AKI with creatinine rise and ongoing oliguria

›KDIGO stage 2 or higher

›Unclear etiology

›Obstruction requiring intervention

›Upper tract obstruction

›Failed catheterization

›Infection requiring IV therapy

›Pyelonephritis

›Bacteremia concern

›Observation pathway

›Prerenal physiology with response to fluids

›Improving urine output

18Discharge Instructions/di45

Copy discharge instructions

›Summary

›Low urine output related to

›Dehydration

›Temporary bladder emptying problem

›Improvement in emergency department

›Urine output improved

›Blood tests stable

›Medications

›Avoid NSAIDs

›Ibuprofen

›Naproxen

›Hold ACE inhibitor or ARB until follow up if instructed

›Resume only after repeat labs

›Follow clinician guidance

›Fluids and diet

›Hydration goal unless fluid restriction

›Clear urine goal

›Stop if shortness of breath worsens

›Avoid high potassium foods until cleared if potassium was high

›Salt substitutes

›Large amounts of juice

›Follow up

›Repeat blood work

›Creatinine

›Potassium

›Timing

›24 to 72 hours

19References/r6

Guidelines and key sources

›Evidence base

›KDIGO Clinical Practice Guideline for Acute Kidney Injury, 2012

›KDIGO Clinical Practice Guideline for AKI update statements, 2023

›Surviving Sepsis Campaign Guidelines, 2021

›American Urological Association guidance on acute urinary retention and obstruction, most recent update local protocol dependent

›National Kidney Foundation guidance on hyperkalemia management, recent consensus statements local protocol dependent

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Oliguria and AnuriaAPPROACH

RENAL AND URINARY · 19 SECTIONS

⚲

639 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Oliguria And Anuria Catheter Related Urinary Complaints Dialysis Patient Presentations Flank Pain And Renal Colic Concern Urinary Retention Hematuria Scrotal Pain

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx76

Urine output pattern

›Urine output characterization

›Oliguria definition

›Adult urine output < 0.5 mL/kg/hour for 6 hours

›Anuria definition

›Adult urine output < 50 mL/day

›Time course

›Sudden onset hours

›Progressive days

›Baseline renal function and urine output

›Prior creatinine trend

›Chronic kidney disease history

OPQRST

›Symptom anchors for associated complaints

›Onset

›Last normal void time

›Abrupt after procedure or trauma

›Provocation/Palliation

›Worse with dehydration

›Relief after catheterization

›Quality

›Suprapubic pressure

›Flank colic pain

›Region/Radiation

›Flank

›Groin radiation

›Severity

›Pain score

02Alarm Features/alarm35

Immediate threats

›Resuscitation triggers

›Shock physiology

›SBP < 90 mmHg

›MAP < 65 mmHg

›Lactate elevation

›Severe hyperkalemia concern

›K 6.5 mmol/L or higher

›ECG changes with elevated K

›Pulmonary edema

›Hypoxemia

›Respiratory distress

›Uremic emergencies

›Encephalopathy

›Pericarditis

›Uncontrolled bleeding

Obstruction red flags

›High risk obstruction features

›Anuria with bladder distension

›Suprapubic pain

›Palpable bladder

›Solitary kidney

›Known nephrectomy

›Transplant kidney

›Bilateral obstruction risk

›Known bilateral stones

›Pelvic malignancy

03Medications/meds45

Nephrotoxic and hemodynamic agents

›Medication exposures

›NSAIDs

›Recent start

›High dose use

›ACE inhibitors

›Recent dose change

›Suspected renal artery stenosis risk

›ARBs

›Recent dose change

›Volume depletion context

›Diuretics

›Overdiuresis risk

›Recent escalation

›Aminoglycosides

›Gentamicin

›Tobramycin

›Vancomycin

›High trough exposure

›Concomitant piperacillin tazobactam exposure

›Calcineurin inhibitors

›Tacrolimus

›Cyclosporine

›Chemotherapy

›Cisplatin

›Ifosfamide

Allergic interstitial nephritis triggers

›Hypersensitivity linked drugs

04Diet/diet13

Intake and hydration

›Recent intake pattern

›Poor oral intake

›Nausea

›Inability to drink

›Excessive losses

›Diarrhea

›Vomiting

›High protein intake

›Catabolic state

›Supplement use

›High potassium intake context

›Salt substitutes

›Large fruit juice intake

05Review of Systems/ros21

System checklist

›Organ system symptoms

›Constitutional

›Fever

›Weight loss

›Cardiopulmonary

›Chest pain

›Dyspnea

›Orthopnea

›GI

›Vomiting

›Diarrhea

›GU

›Dysuria

›Hematuria

›Flank pain

›Neuro

›Confusion

›Seizure

›Skin and MSK

›Rash

›Myalgias

06Collateral History and Family History/chafh10

Collateral and inherited risk

›Additional sources and inherited conditions

›Collateral source reliability

›Caregiver report

›Medication list verification

›Family renal disease

›Polycystic kidney disease (Q61.2)

›Alport syndrome

›Early cardiovascular disease

›MI or stroke before age 55 male relative

›MI or stroke before age 65 female relative

07Risk Factors/rf26

AKI susceptibility and exposures

›Risk profile

›Chronic kidney disease (N18.9)

›Baseline eGFR reduction

›Proteinuria history

›Diabetes mellitus (E11.9)

›Microvascular disease

›Diabetic nephropathy history

›Heart failure (I50.9)

›Cardiorenal physiology risk

›Diuretic dependence

›Cirrhosis (K74.60)

›Ascites

›Hepatorenal syndrome risk

›Sepsis or severe infection

›Recent bacteremia

›ICU stay

›Obstructive uropathy risk

›BPH (N40.1)

›Pelvic malignancy history

›Neurogenic bladder (N31.9)

›Vascular risk

›Atherosclerosis

›Known renal artery stenosis

›Pregnancy related risk

›Preeclampsia (O14.9)

›HELLP syndrome

08Differential Diagnosis/ddx49

Life threatening

›Immediate risk diagnoses

›Hyperkalemia with malignant arrhythmia

›Bradycardia

›Ventricular tachyarrhythmia

›Urosepsis with obstructive uropathy

›Fever with flank pain

›Hypotension

›Bilateral ureteral obstruction

›Anuria

›Hydronephrosis

›Acute glomerulonephritis with pulmonary renal syndrome

›Hemoptysis

›Rapid creatinine rise

›Thrombotic microangiopathy

›Hemolysis

›Thrombocytopenia

›Acute renal infarction

›Sudden flank pain

›LDH elevation

Common

›Common causes by category

›Prerenal azotemia

›Hypovolemia

›Low effective arterial blood volume

›Acute tubular injury or necrosis (N17.0)

›Sepsis associated

›Ischemic hypotension

09Past Medical History/pmh16

Baseline renal and urologic history

›Relevant prior conditions

›Chronic kidney disease stage

›Prior eGFR baseline

›Dialysis history

›Prior urinary retention episodes

›Catheterization history

›Known BPH

›Urolithiasis history

›Prior obstructing stone

›Prior stent placement

›Renal transplant history (Z94.0)

›Immunosuppression regimen

›Prior rejection episodes

›Recent hospitalization

›Sepsis

›Contrast studies

10Physical Exam/exam36

Vitals and general

›Global assessment

›Vital sign patterns

›Hypotension

›Fever

›Tachycardia

›Volume status

›Dry mucous membranes

›Orthostatic changes

›Capillary refill delay

›Fluid overload

›Elevated JVP

›Crackles

›Peripheral edema

Focused abdominal and GU

›Abdominal and GU findings

›Bladder distension

›Suprapubic fullness

›Suprapubic tenderness

›Costovertebral angle tenderness

›Unilateral

›Bilateral

›Genital exam when relevant

›Phimosis

›Paraphimosis

›Rectal exam when indicated

›Prostate enlargement

›Prostate tenderness

11Lab Studies/labs46

Core AKI panel

›Initial labs

›BMP

›Creatinine trend

›Potassium

›Bicarbonate

›CBC

›Leukocytosis

›Anemia

›Venous blood gas

›pH

›Lactate

›Urinalysis with microscopy

›Hematuria

›Proteinuria

›Casts

›Urine culture when infection possible

›Pyuria

›Nitrites

Urine indices and interpretation

›Urine chemistry patterns

›Urine sodium

›Low urine sodium supportive of prerenal states

›Limitations in diuretic use

›FENa

›< 1 percent supportive of prerenal physiology

›Unreliable with diuretics

›FEUrea

12Imaging/img44

Scoring Systems

›AKI staging and urine output criteria

›KDIGO AKI stage

›Stage 1

›Creatinine 1.5 to 1.9 times baseline or 0.3 mg/dL increase

›Urine output < 0.5 mL/kg/hour for 6 to 12 hours

›Stage 2

›Creatinine 2.0 to 2.9 times baseline

›Urine output < 0.5 mL/kg/hour for 12 hours or longer

›Stage 3

›Creatinine 3.0 times baseline

›Creatinine 4.0 mg/dL or higher

›Dialysis initiation

›Urine output < 0.3 mL/kg/hour for 24 hours or longer

›Anuria for 12 hours or longer

›Limitations

›Creatinine lag in early AKI

›Baseline creatinine uncertainty

MRI

›MRI applications

›Renal artery imaging

›MRA when CTA contraindicated

›Gadolinium risk in advanced CKD

›Renal mass evaluation

›Indeterminate lesion characterization

›Contrast avoidance considerations

›CT pathways

13Special Tests/spec13

Bedside diagnostics and procedures

›Bedside tests

›Bladder scan

›High post void residual supportive of retention

›Guides catheterization

›Foley catheterization

›Immediate urine return supportive of outlet obstruction

›Monitor post obstructive diuresis risk

›Urine microscopy interpretation

›Muddy brown casts supportive of acute tubular injury

›RBC casts supportive of glomerulonephritis

›Fluid challenge response

›Small bolus strategy when not overloaded

›Lack of response suggests intrinsic or obstructive etiologies

14ECG/ecg12

Hyperkalemia and uremic complications

›ECG priorities

›Hyperkalemia patterns

›Peaked T waves

›PR prolongation

›QRS widening

›Sine wave risk

›Arrhythmias

›Bradycardia

›Ventricular tachycardia

›Uremic pericarditis clues

›Diffuse ST elevation possibility

›Clinical correlation required

15Assessment/ax16

Categorize AKI and urgent complications

›Working problem list

›Oliguria or anuria with suspected AKI (N17.9)

›Prerenal

›Intrinsic renal

›Postrenal

›Severity stratification

›KDIGO stage based on creatinine and urine output

›Rate of rise of creatinine

›Immediate complications to rule out

›Hyperkalemia

›Severe metabolic acidosis

›Pulmonary edema

›Obstructed infected system

›Diagnostic uncertainty flags

›Unknown baseline creatinine

›Mixed prerenal and intrinsic physiology

16Plan/plan90

Differential Management

›!Acute Kidney Injury (Pre-renal)→›!Acute Kidney Injury (ATN)→›Acute Kidney Injury (Post-renal)→›Urinary Retention→

First 5 minutes

›Time critical actions

›Monitoring and access

›Cardiac monitor if K elevation suspected

›IV access

›Immediate point of care checks

›Fingerstick glucose if altered

›ECG if K elevation suspected

›Rapid obstruction screen

›Bladder scan

›Foley catheter if retention likely

›Severe hyperkalemia treatment if present

›Calcium gluconate IV 1 g

›Repeat dose if ECG changes persist after 5 to 10 minutes

›Insulin regular IV 10 units with dextrose

›Dextrose 25 g IV if glucose < 14 mmol/L

›Nebulized albuterol 10 to 20 mg

›Sodium bicarbonate IV if severe acidosis

›Dialysis activation for refractory hyperkalemia

Diagnostic sequencing

›Initial diagnostic path

›Labs

›BMP for K and bicarbonate

›Urinalysis with microscopy

›Infection evaluation when indicated

›Blood cultures

›Lactate

›Imaging for obstruction

›Bedside bladder scan then Foley

›Renal ultrasound if anuria or persistent oliguria

Fluids and hemodynamics

›Volume and perfusion management

›Hypovolemia without overload

›Isotonic crystalloid 500 mL bolus

›Reassess after each bolus

›Heart failure or pulmonary edema

›Avoid empiric fluids

›Noninvasive ventilation if needed

›Shock or sepsis

›Local protocol dependent resuscitation volumes

›Early vasopressor if fluid nonresponsive

Treat reversible causes

›Etiology directed actions

›Postrenal

›Foley for suspected outlet obstruction

›Urology consult for failed catheterization

›Nephrostomy consideration for upper tract obstruction

›Suspected pyelonephritis with obstruction

›Broad spectrum antibiotics

›Urgent decompression pathway

›Medication related AKI

›Stop NSAIDs

›Hold ACE inhibitor and ARB during AKI

›Review nephrotoxin combinations

›Suspected glomerulonephritis

›Nephrology consult

›Avoid delay in workup when pulmonary hemorrhage concern

›Rhabdomyolysis

›Isotonic crystalloid infusion

›CK trend monitoring

Reassessment loop

›Time based reevaluation

›Urine output monitoring

›Hourly in severe AKI

›Foley output measurement

›Repeat labs

›Potassium recheck within 1 to 2 hours if treated

›Creatinine and bicarbonate within 4 to 6 hours if unstable

›Fluid balance and respiratory status

›Lung findings

›Oxygen requirement changes

›Post obstructive diuresis monitoring

›Urine output > 200 mL/hour for 2 hours

›Electrolyte monitoring frequency escalation

Renal replacement therapy triggers

›Dialysis indications

›Refractory hyperkalemia

›Persistent K 6.5 mmol/L or higher

›Ongoing ECG changes

›Refractory pulmonary edema

›Hypoxemia despite therapy

›Volume overload not diuretic responsive

›Severe metabolic acidosis

›pH < 7.1 with clinical deterioration

›Refractory to temporizing therapy

›Uremic complications

›Pericarditis

›Encephalopathy

›Bleeding with suspected uremic platelet dysfunction

›Toxin ingestion

›Local protocol dependent dialyzable toxins

›Poison control guidance

17Disposition/dispo40

Level of care criteria

›ICU or monitored bed

›Severe hyperkalemia treated or ongoing risk

›ECG changes

›K 6.0 mmol/L or higher with AKI

›Respiratory failure or pulmonary edema

›Noninvasive ventilation

›Rising oxygen needs

›Shock or sepsis

›Vasopressors

›Lactate elevation with instability

›Dialysis initiation or imminent need

›AEIOU indications present

›Rapidly rising K or acidosis

Admission and observation

›Inpatient admission

›New AKI with creatinine rise and ongoing oliguria

›KDIGO stage 2 or higher

›Unclear etiology

›Obstruction requiring intervention

›Upper tract obstruction

›Failed catheterization

›Infection requiring IV therapy

›Pyelonephritis

›Bacteremia concern

›Observation pathway

›Prerenal physiology with response to fluids

›Improving urine output

18Discharge Instructions/di45

Copy discharge instructions

›Summary

›Low urine output related to

›Dehydration

›Temporary bladder emptying problem

›Improvement in emergency department

›Urine output improved

›Blood tests stable

›Medications

›Avoid NSAIDs

›Ibuprofen

›Naproxen

›Hold ACE inhibitor or ARB until follow up if instructed

›Resume only after repeat labs

›Follow clinician guidance

›Fluids and diet

›Hydration goal unless fluid restriction

›Clear urine goal

›Stop if shortness of breath worsens

›Avoid high potassium foods until cleared if potassium was high

›Salt substitutes

›Large amounts of juice

›Follow up

›Repeat blood work

›Creatinine

›Potassium

›Timing

›24 to 72 hours

19References/r6

Guidelines and key sources

›Evidence base

›KDIGO Clinical Practice Guideline for Acute Kidney Injury, 2012

›KDIGO Clinical Practice Guideline for AKI update statements, 2023

›Surviving Sepsis Campaign Guidelines, 2021

›American Urological Association guidance on acute urinary retention and obstruction, most recent update local protocol dependent

›National Kidney Foundation guidance on hyperkalemia management, recent consensus statements local protocol dependent

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.