Simplified Approach to Acute Kidney Injury (AKI)

1) IS THIS AN EMERGENCY? 

Is there a dialysis indication (e.g AEIOU ) or anuria that may require urgent nephrology evaluation?

2) HISTORY/PHYSICAL

Assess if patient has common culprits: Hypovolemia, Low effective circulating volume, Urinary obstruction, Nephrotoxic drugs (e.g NSAlDs)

3) FIX THE PROBLEM

~80% of AKI cases are caused by prerenal azotemia or postrenal obstruction: 

 • Trial isotonic fluids (NS or LR)

 • Obtain post-void residual to assess for obstruction

4) EVALUATE FOR IMPROVEMENT

If the urine output and creatinine (in 12-24 hours) has improved, you confirmed diagnosis! If not. go on to step 5...

5) CONSIDER INTRINSIC CAUSES

Assess UA w/ microscopy for WBCs, RBCs, casts, crystals, protein. - 80% of intrinsic etiologies due to ATN.

 • Rx: Time + minimize culprit



- Dr. Michael Lorinsky @LorinskyMD



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