Table 4.
Diverse causes and clinical findings of AKI
| Clinical findings | Important laboratory values | Urinary findings | |
|---|---|---|---|
| Acute cardiorenal/renocardial syndrome | Renal and cardiac failure, lung oedema/hypervolemia | ↑BNP | – |
| Sepsis | Systemic inflammatory response syndrome | ↑C-reactive protein, ↑procalcitonin, leukocytosis | (Leukocyturia) |
| Tumour lysis syndrome | ↑Uric acid ↑LDH, ↑CK, ↑K+, Phosphate ↓Ca2+ |
(Urate crystals) | |
| Hepatorenal syndrome | Ascites, cholestasis, oedema, portale hypertension | Hyponatraemia, ↑ GOT/GPT |
Proteinuria <0.5 g/day urinary Na+ <10 mmol/l urinary osmolarity > serum osmolarity |
| Systemic autoimmune diseases | |||
| ANCA vasculitis | Constitutional symptoms, arthralgia, purpura, sinusitis, epistaxis, haemoptysis | Inflammation, ↑ANCA, ↑anti-PR3/-MPO | Glomerular erythrocyturia, proteinuria |
| Systemic lupus erythematosus | Constitutional symptoms, arthralgia, (butterfly) rash, alopecia, oral ulcerations | Inflammation, leukopenia, thrombopenia, ↓C3, C4, ↑ANA, ↑anti-dsDNA | Glomerular erythrocyturia, proteinuria |
| IgA vasculitis | Constitutional symptoms, arthralgia, abdominal pain, purpura, bloody stool | Inflammation | Glomerular erythrocyturia, proteinuria |
| Thrombotic microangiopathy | |||
| TTP | Constitutional symptoms, neurologic symptoms, bleeding signs | Thrombopenia ↓Hb, ↓haptoglobin, ↑LDH, ↓ADAMTS13 activity |
|
| STEC-HUS | Constitutional symptoms, diarrhoea, bleeding signs, renal failure | Thrombopenia, ↓Hb, ↓haptoglobin, ↑LDH, Shiga toxin in stool | – |
| aHUS | Constitutional symptoms, bleeding signs, renal failure | Thrombopenia, ↓Hb, ↓haptoglobin, ↑LDH, complement abnormalities | – |
| AIN | |||
| Drug induced | Fever, nausea, rash, flank pain | Inflammation, ↑eosinophils | Haematuria, leukocyturia, eosinophiluria, mild proteinuria |
| Infectious agents | Depending on the type of infection | Inflammation | Haematuria, leukocyturia, proteinuria |
| ‘TINU’ | Constitutional symptoms, uveitis | Inflammation | Haematuria, leukocyturia, proteinuria |
| IgG4-related kidney disease | Extrarenal manifestations: lymph node swelling, salivary gland swelling, etc. | ↑Total IgG, IgG4, ↑IgE, ↑eosinophils, ↓C3, C4 | Haematuria, leukocyturia, proteinuria |
| Renal allograft failure | |||
| Rejection | ↑Serum creatinine, antibody-mediated rejection: donor-specific antibodies | – | |
| Polyoma virus-nephropathy | Viral load in serum | – | |
| cytomegaly disease | Viral load in serum | – | |
| Urinary tract infection/pyelonephritis | Dysuria, fever | Inflammation | Leukocyturia, nitrite positive, bacteria |
| Recurrence of primary disease | Depending on primary disease | Depending on primary disease | Depending on primary disease |
| CNI toxicity (acute) | (Neurotoxic side effects) | ↑CNI trough levels | – |