Causes of Acute Kidney Injury (AKI) - Differential Diagnosis Algorithm

Acute Kidney Injury (AKI) - Acute increase in creatinine by at least 50%

Renal Hypoperfusion

 • Hepatorenal syndromes

 • Drugs

 • Emboli

Systemic Hypotension

 • Shock 

Acute Tubular Necrosis (Epithelial cell casts)

 • Ischemia (severe hypotension)

 • Toxins (contrast, aminoglycosides, chemotherapy)

 • Pigments

Tubular Obstruction

 • Cast nephropathy (multiple myeloma)

 • Urate crystals

 • Calcium Oxalate (Ethylene glycol)

TTP/HUS

 • Shiga-like toxin (E. coli)

 • Drugs

 • HIV

 • Malignancy

Rapidly Progressive Glomerulonephritis

 • Anti-GBM antibodies

 • Immune-complex deposition (IgA, post-strep, lupus)

 • Pauci-immune (Granulomatosis with polyangiitis /microscopic polyangiitis)

Acute Interstitial Nephritis

 • Drugs (NSAlDs, Abx, allopurinol, PPI)

 • Infections (CMV, strep, legionella)

 • Immune (lupus, sarcoid, Sjögren)

Post-Renal (Obstruction/hydronephrosis on UIS)

 • Benign Prostatic Hyperplasia

 • Constipation

 • Prostate Cancer

 • Urolithiasis



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