ABCs
- Check vitals & If unstable → call for assistance
- Send urgently: RFTs + VBG
- Monitor
- Urine output
- Fluid balance
- Criteria
- ↑ Creatinine ≥ 1.5× baseline (within 7 days)
- OR ↑ Creatinine ≥ 26.5 μmol/L (within 48 hrs)
- OR Urine output < 0.5 mL/kg/hr for ≥ 6 hrs
| INDICATIONS FOR URGENT DIALYSIS |
|---|
| Refractory acidosis (pH < 7) |
| Refractory hyperkalemia |
| Intoxication (e.g., methanol, ethylene glycol) |
| Refractory volume overload |
| Uremia (encephalopathy, pericarditis) |
Causes
| Category | Common Causes |
|---|---|
| Pre-renal | Hypovolemia (dehydration, bleeding, GI loss) Low effective volume (CHF, cirrhosis, nephrotic syndrome) Drugs: NSAIDs, ACEi/ARB, SGLT2i, Renal venous congestion |
| Intrinsic renal | ATN (ischemia, toxins e.g. aminoglycosides, contrast, rhabdomyolysis) Glomerular disease (RPGN, nephritic/nephrotic) AIN (drugs, autoimmune) Vascular (vasculitis, TTP/HUS) Other: myeloma, TLS |
| Post-renal | BPH, prostate cancer, stones, strictures, tumours, bladder outlet obstruction |
| Mixed / Other | CKD + AKI overlap Atheroembolism Sepsis + medications |
HPI & examination
- Clues to Cause
- Pre-renal Vomiting, diarrhea, bleeding, sepsis, hypotension
- Post-renal Oliguria/anuria, retention, incontinence, dysuria, frequency, stones, BPH
- Medication Review
- NSAIDs
- ACEi / ARBs
- Diuretics
- IV contrast
- Antibiotics
- Symptoms of Uremia
- Anorexia, nausea, vomiting
- Metallic taste
- Confusion
- Examination
- Volume status: Depleted vs overloaded
- Bladder: Distention, retention
- Kidneys: Flank pain
- Uremia: Encephalopathy, asterixis
- Chronic disease: AV fistula
- Signs of liver disease
Management
- General
- Stop nephrotoxins
- Monitor U&E + fluid output
- Hypovolemic → IV fluids
- Volume overload → Loop diuretics
- RFTs, U&Es, VBG Urine analysis + microscopy → correct electrolytes
- If indicated: CK (rhabdomyolysis) & ultrasound / CT KUB (obstruction)
- Foley & Obstruction
- Insert/replace Foley
- Post-obstructive diuresis
- UOP > 200 mL/hr (≥2 hrs)
- OR > 3 L / 24 hrs
- → Replace fluids + monitor closely
- Consult nephrology/urology if indicated
| Situation | Recommendation |
|---|---|
| eGFR >30 | LMWH safe |
| eGFR <30 | Use UFH |
| Platelets < 30 or bleeding | Avoid |
Studying for R1? The IM Rapid Review covers this in the same format — see the sample chapter.
Last reviewed · May 2026