Sandbox:Sahar

Renal failure

Is this acute or chronic renal failure

❑ History and physical examination ❑ Previous creatinin measurement ❑ Small kidneys on ultrasound except in diabetes

Has obstruction been excluded?

❑ Complete anuria ❑ Palpable bladder ❑ Renal ultrasound

Is the patient euvolemic?

❑ Check pulse, JVP, orthostatic hypotension, daily weights, fluid balance ❑ Check for BUN/Cr ratio ❑ Check for urinary sodium ❑ Do fluid challeng test

Does evidence of renal parenchymal disease exist? (other than ATN)

❑ History and physical examination (clinical features) ❑ Check urine dipstick and microscopy for RBC, WBC, and protein sodium

Has a major vascular occlusion occurred?

❑ Ask for a history of atherosclerotic vascular disease ❑ Check for renal asymmetry ❑ Check for loin pain ❑ Check for macroscopic hematuria ❑ Check for complete anuria