The most simplified steps to find out the cause of acute kidney injury.

1. Approach to
Acute Kidney Injury in ICU
Simplified
Muhammad Asim Rana
BSc, MBBS, MRCP, MRCPS, FCCP, EDIC, SF-CCM
Department of Critical Care Medicine
King Saud Medical City, Riyadh, Saudi Arabia

2. Acute Renal failure in ICU

3. What initial steps to do?
• History and physical examination
• Review Medications
• Urine Electrolytes
• Urine Osmolality
• Urine Examination
– Urine Cast
• Serum Electrolytes
• Serum Osmolality

4. What initial steps to do?
• Monitor urine output
• Assess volume status of your patient
• Adjust the necessary medicine doses
• Avoid further insult to kidneys
• Rule out obstruction

5. Obstruction in urine outflow?
• Foly’s catheter
• Ultrasound exam of abdomen
• Obstruction proved?
• Post Renal Azotemia
• Urology Review

6. No Obstruction
• Volume status?
• FENa < 1
• Urine Osmolality > 500
• Few Hyaline casts in urine analysis
• HYPOVOLEMIA
• Pre-Renal Azotemia

7. Pre-Renal Azotemia
Evidence of Congestive Heart Failure
YES
• Hemodynamic monitoring
• Optimize Cardiac Output
• May need to improve
intravascular volume
NO
• Hypovolemia
• Volume relpacement
• Follow response
– Urine output
– Serum electrolytes
– Renal parameters

8. No evidence of Pre-Renal problem
Renal Azotemia
• RBC Cast
• Dysmorphic
RBCs
• Urine Osm> 500
• FENa < 1
• Pigmented
Granular Cast
• Urine
Osm<350
• FENa>1
• Urine
eosinophilia
• Skin rash?
• Urine
Osm<350
• FENa>1
Glomerulonephritis Acute tubular
necrosis
Interstitial nephritis
Nephrology Review

9. Thank You
Questions?