clinical assessment of acute kidney injury

Clinical assessment:

History and examination

• clinical assessment of the patient with acute kidney injury (AKI) starts with a comprehensive history including a review of:
  • patient notes
    
    
  • AKI risk factors
    • age > 75 yrs
    • chronic kidney disease (CKD, eGFR < 60 mls/min/1.73m2)
    • Cardiac failure
    • Atherosclerotic peripheral vascular disease
    • Liver disease
    • Diabetes mellitus
    • Nephrotoxic medications
      
      
  • potential causes for AKI including
    • reduced fluid intake
    • increased fluid losses
    • urinary tract symptoms
    • recent drug ingestion
    • sepsis
      
      
  • systemic clinical features
    • fever
    • rash
    • joint pains

Clinical examination must include:

• general
  • rash
  • uveitis
  • joint swelling
    
    
• assessment of volume status
  • core temperature
  • peripheral perfusion
  • heart rate
  • blood pressure
  • jugular venous pressure
    
    
• signs of renovascular disease
  • audible bruits
  • impalpable peripheral pulses
    
    
• abdominal examination
  • palpable bladder

Reference:

• UK Renal Association (2011). Acute Kidney Injury.

Last reviewed 01/2018