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 ❑ NSAIDs-associated with interstitial kidney disease ❑ Penicillins-associated with renal papillary necrosis ❑ inquire about recent hospitalization-rule out ATN ❑ Inquire about recent trauma/surgery-rule out sepsis-look for fever and hypotension/rule out hemorrhage and hypovolemia ❑ Age factor-elderly people-rule out Benign Prostate hypertrophy/prostate cancer ❑ Elderly patient with bone pain-Multiple Myeloma? ❑ History of kidney stones ❑ Associated symptoms ❑ Nasal stuffiness/epistaxis-suggest Wagener's Granulomatosis? ❑ recent sore throat-streptococcal Glomerulonephritis ❑ Social history-Alcohol use/tobacco use/drug abuse ❑ history of autoimmune disorders- Systemic Lupus Erythromatosus, Good Pasture syndrome

Initial work-up ❑ 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?