Sandbox:Sahar

History and Physical Eexamination Ask for urinary symptoms such as: ❑ Dysuria ❑ Hematuria Physical Examination should asses for the presence of: ❑ Hypotension ❑ Pallor ❑ Edema ❑ Muffled heart sounds ❑ Swollen joints ❑ Organomaegally ❑ Lymphadenopathy ❑ Abdominal and pelvic examination ❑ Digital rectal examination ❑ Vaginal examination (in female)

Laboratory Investigations Check for urinanalysis and urine cullture ❑ Midstream clean catch is preferred. ❑ Avoid the use of antiseptic solutions prior to collection. Check routine blood tests such as: ❑ Complete blood count ❑ Liver function test ❑ Renal function test Perform a vaginal swab in sexually active patients ❑ Chlamydia ❑ Gonorrhoea In case of suspicion to urinary tuberculosis: ❑ Consider 3 consecutive first-void morning samples for acid-fast bacilli and polymerase chain reaction (PCR) testing In case of suspicion to schistosomiasis: ❑ Consider collecting a terminal urine sample between noon and 3 pm

Imaging Studies ❑ Basic Blood ❑ Full blood count with differentials ❑ Blood glucose ❑ Urea and electrolytes ❑ Coagulation screen ❑ Inflammatory markers ❑ Urea/electrolytes ❑ Liver function test ❑ Calcium and phosphate ❑ Blood culture if infection suspected ❑ Arterial blood gases or venous bicarbonate ❑ Urine analysis ❑ Urine microscopy/urine sediment/culture ❑ Renal ultrasound ❑ Chest radiograph ❑ ECG ❑ Renal biopsy may be indicated if intrinsic cause is suspected

Draw a conclusion ❑ Treat any life threatening features first—shock, respiratory failure, hyperkalaemia ❑ Is this acute or chronic renal impairment? ❑ A full drug history (current, recent, and alternative medication) is vital ❑ Is there a pre‐renal cause? What is the patient's current fluid status? ❑ Could this be obstruction? ❑ Is intrinsic renal disease probable—what does urine analysis show?