Causes of Acute Kidney Injury (AKI) - Differential ...
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Causes of Acute Kidney Injury (AKI) - Differential Diagnosis - Pre-Renal, Intrinsic and Post-Renal 

PRE-RENAL (21%) 

 • Absolute ↓ volume - Bleeding, GI or skin loss, Diuretics, Osmotic diuresis, Cerebral salt wasting

 • Effective ↓ volume - CHF / cardiorenal, Cirrhosis / hepatorenal, Nephrotic syndrome, Sepsis / Third-spacing

 • Δ renal dynamics - NSAIDs / COX-2s, ACEi / ARBs, Abd compart. syndr.

 • Relative hypotension

INTRINSIC 

GLOMERULAR (<4%)

 • Anti-GBM, ANCA+ - Microscopic polyangitis, Granulomatosis with polyangiitis (GPA), Eosinophilic GPA, Drug-induced ANCA

 • Immune complex

   - Low complement: PSGN, SLE, cryo, MPGN, MGRS

   - Normal complement: IgA nephropathy/HSP, Fibrillary/immunotactoid

TUBULO-INTERSTITIAL

 • ATN (45%) - Ischemic, sepsis, toxic (contrast, rhabdo, aminoglycosides)

 • AIN (2%) 1) Allergic: meds (abx, PPI, NSAIDs, allopurinol) 2) Infectious: CMV, lepto, legionella 3) Auto-immune / infiltrative: TINU, IgG4 disease, sarcoid

 • Crystals: TLS, acyclovir, ethylene glycol

 • Proteins: MM, amyloid, Ig deposition

VASCULAR

 • Microvascular (<4%) - TTP/HUS, APLAS, HELLP, Eclampsia, Scleroderma, Malignant HTN, Meds (calcineurin inhib/CIN, gemcitabine)

 • Atheroembolic (1%)

 • Macrovascular - RAS (athero, FMD), Dissection, Renal artery/vein thrombosis

POST-RENAL (10%)

 • Urinary retention - BPH, meds, neurogenic, Foley dysfunction

 • Urinary obstruction (bilateral) - Stones (single kidney/transplant), Clot, Malignancy, Retroperitoneal fibrosis



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