Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
Approach AKI by distinguishing pre‑renal, intrinsic, and post‑renal causes. Trend creatinine and urine output, perform urinalysis with microscopy, and assess hemodynamics and exposures (nephrotoxins, contrast, ACEi/ARB, NSAIDs). Point‑of‑care ultrasound helps evaluate volume status and obstruction. Anticipate complications—hyperkalemia, acidosis, and fluid overload—that drive urgent interventions.
Treatment Strategy & Disposition
Optimize perfusion with judicious fluids when hypovolemic; discontinue nephrotoxins and adjust drug dosing. Treat hyperkalemia and severe acidosis promptly; initiate renal replacement therapy for AEIOU indications. Coordinate imaging with contrast only when benefits outweigh risks, using preventive strategies. Disposition depends on trajectory and complications—ICU for refractory electrolyte/volume issues or hemodynamic instability; otherwise monitored ward care.
Epidemiology / Risk Factors
- Risk factors vary by condition and patient profile
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Baseline hematology | Abnormal counts | |
| BMP | Electrolytes/renal | Derangements |
Classic Clinical Features
| Feature | Example |
|---|---|
| Conjunctivitis | Non exudative |
| Oral changes | Strawberry tongue, cracked lips |
| Rash and extremity changes | Edema or peeling |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| IVIG | Immune modulation | Hours | Reduce coronary aneurysm risk | Aseptic meningitis |
| High-dose aspirin | COX inhibition | Hours | Anti-inflammatory then antiplatelet | Reye risk (monitor) |
Prognosis / Complications
- Prognosis depends on severity, comorbidities, and timeliness of care
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Assess for sterile pyuria and elevated inflammatory markers. Counsel about live vaccines after IVIG.