Renal failure

Key Information

Appropriate Tests

Acute 

Clinical assessment and diagnostic imaging as appropriate.

Electrolytes, Creatinine, Urea.

Urine microscopy, Sodium urine, Creatinine urine (with calculation of fractional excretion of sodium, to distinguish pre-renal from renal failure), Osmolality urine.

Full blood count, Blood film.

Renal biopsy with immunofluorescence and electron microscopy, if cause uncertain or confirmation required.

See also Oliguria

Acute tubular necrosis

  • Shock
  • Haemoglobinuria
  • Myoglobinuria

 

Acute glomerulonephritis, especially

  • Crescentic glomerulonephritis
  • Vasculitis
  • Goodpastures syndrome

 

Antineutrophil cytoplasmic Ab, Glomerular basement membrane Ab.

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. See Hyperuricaemia

  • Plasma cell 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, Alkaline phosphatase, Full blood count, Blood film.

Urine - microscopy, Protein urine.

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

Monitoring should include Electrolytes, Creatinine, Urea.

Glomerulonephritis

 

Diabetes mellitus

 

Hypertension

 

Plasma cell 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; Phosphate urine, Amino acids, Bone marrow aspiration (cystine crystals), if indicated.

  • Uraemic medullary cystic disease

 

  • Primary oxalosis

Oxalate urine.

Complications including

 

Acidosis - metabolic

Sodium, Potassium, Bicarbonate, Chloride, Anion gap, Phosphate.

See also Acidosis

Anaemia of renal disease

 

Bleeding

See Bleeding disorders

  • Thrombocytopenia, especially

 

  • Microangiopathic haemolysis

 

  • 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

  • Vitamin K deficiency

Usually nutritional.

Renal osteodystrophy

See secondary and tertiary Hyperparathyroidism and Osteomalacia.

Hypocalcaemia

See Hyperparathyroidism

Hyperphosphataemia

 

Ectopic calcification

 

Hyperkalaemia

 

Hyperlipidaemia

 

Hypertension

 

Hyperuricaemia

 

Fluid overload

See Oedema

Hyponatraemia

 

Immunodeficiency

 

Infertility

Infertility (male and female)

Neuropathy

 

Peptic ulcer

 

Pericarditis

 

Pruritis

 

Dialysis complication

 

Haemodialysis

 

Anaemia

 

  • Blood loss - chronic

See Iron deficiency

  • Folate 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