Approach to a patient with acute kidney injury

Acute renal failure (ARF) has traditionally been defined as the abrupt loss of kidney function resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes. Management of patients with acute kidney injury (AKI) is principally supportive, with renal replacement therapy (RRT) indicated in patients with severe kidney injury. Mortality in patients with ARF remains high >50% in severely ill patients. There are numerous causes of ARF, some of which are amenable to specific therapeutic interventions. For these interventions to be effective, they must usually be applied early in the course of the disease process. It follows that key considerations in the diagnosis of ARF are early detection and timely evaluation to determine the cause of the disorder. Therefore, a correct diagnosis and earliest detection of a particular disorder may save both time and patient. History and physical examination give us clues to look for the earliest features. How to approach AKI and detect its varied presentations and manifestations are discussed briefly.