Renal failure

Last updated: Friday, 28, January, 2011
Key InformationAppropriate Tests

Acute 

Clinical assessment and diagnostic imaging as appropriate.

Electrolytes, creatinine, urea.

Urine microscopy, sodium, creatinine (with calculation of fractional excretion of sodium, to distinguish pre-renal from renal failure), osmolality.

FBC, blood film.

Renal biopsy, if cause uncertain or confirmation required.

See also Oliguria

Acute tubular necrosis 

  • Shock
  • Haemoglobinuria
  • Myoglobinuria

Acute Glomerulonephritis, especially 

  • Crescentic GN
  • Vasculitis
  • Goodpasture syndrome

 

Antineutrophil cytoplasmic antibodies, glomerular basement membrane antibodies.

Acute cortical necrosis, especially

  • Post-partum

Renal tubulo-interstitial disorders, especially

  • Drugs/toxins
    • Aminoglycosides
    • NSAID
    • Heavy metals


Antibiotic assay, as appropriate.

See Heavy metal exposure/toxicity

  • Crystal nephropathy, especially
    • Urate


Urate Urate; urine - urate. See Hyperuricaemia

  • Multiple myeloma

Dehydration is associated with an increased risk of acute renal failure, especially in association with intravenous pyelography.

Complete post-renal obstruction, including

  • Retroperitoneal tumour/fibrosis

Acute bilateral renovascular occlusion, especially

  • Dissecting aortic aneurysm

Haemolytic uraemic syndrome

Acute renal transplant rejection

Chronic 

Creatinine, urea; creatinine clearance; urate, phosphate, calcium, albumin, ALP; FBC, blood film.

Urine - microscopy; protein.

Renal biopsy to determine nature and severity of underlying disease process.

Monitoring should include electrolytes, creatinine, urea.

Glomerulonephritis

Diabetes mellitus

Hypertension

Multiple myeloma

  • Analgesic nephropathy
See also Analgesic abuse

Reflux nephropathy 

Amyloidosis

Chronic renal transplant rejection

Genetic disorders, especially

  • Polycystic kidney disease
See Cystic renal disease
  • Hereditary nephropathies, especially
    • Alport syndrome
    • Nephropathic cystinosis

Consult pathologist; urine - phosphate, amino acids; bone marrow aspiration (cystine crystals), if indicated.

    • Uraemic medullary cystic disease
    • Primary oxalosis

Urine - oxalate.

Complications including

Acidosis - metabolic

Sodium, potassium, bicarbonate, chloride, anion gap, phosphate.

See also Acidosis

Anaemia of renal disease

Bleeding

See Bleeding disorders
    • Immunosuppressive/cytotoxic drug therapy
  • Platelet dysfunction

Predictable finding in uraemia; the bleeding time does not correlate with risk of spontaneous or surgical bleeding and is not helpful.

Platelet aggregation/release studies are rarely indicated as the findings are predictable.

See Platelet disorders

Usually nutritional.

Renal osteodystrophy 

See secondary and tertiary Hyperparathyroidism and Osteomalacia.

Hypocalcaemia

Hypercalcaemia

See Hyperparathroidisim

Hyperphosphataemia

Ectopic calcification

Hyperkalaemia

Hyperlipidaemia

Hypertension

Hyperuricaemia

Fluid overload

See Oedema

Hyponatraemia

Immunodeficiency

Infertility

Neuropathy

Peptic ulcer

Pericarditis

Pruritus

Dialysis complication

Haemodialysis

Anaemia

  • Blood loss - chronic 

See Iron deficiency

Blood transfusion complications 

See under Blood transfusion

Hypersplenism

Amyloidosis

Aluminium toxicity 

Aluminium

Renal cystic disease

See Cystic renal disease

Peritoneal dialysis

Catheter tunnel infection

Peritonitis

Immediate assessment required if abdominal pain, or cloudy dialysis fluid noted: dialysis fluid - microscopy and culture.

Protein loss

Protein (total), albumin.

Hernia formation