Acute kidney injury – ‘screen’ (tests)

 

All of these tests should be considered in patients with acute renal failure. Be selective, but keep an open mind even if the diagnosis appears to be clear. The list applies also to patients with a lesser degree of renal impairment who have an acute or immunological renal illness. The blue spot indicates ­ do it in everyone.

 

Test Essential? Comments
FBC + plats, film, diff
film essential in ARF
(ESR)   misleading; do CRP instead
CRP
 
Clotting screen
additional tests if abnormal
Group & save
 
Biochemistry
 
Calcium + phosphate
even a high-normal Ca is abnormal
Myoglobin , CK   if rhabdomyolysis possible
     
Blood cultures
do in almost all with ARF of whatever cause
Other cultures   wound, sputum, catheters etc
Hepatitis and HIV serology   Urgent HepB +HIV may need dialysis; but also for other disease
CMV, VZV   If to be immunosuppressed; consider EBV and HIV also
ASOT/ throat swab/ other   if post-strep GN possible
Other serology   leptospires, syphilis, hantavirus, etc., (rarely)
MSU
 
Bence Jones protein   patients >35y with poorly explained ARF
Urinary prot
24h or spot protein/creatinine ratio
CXR
 
Renal Ultrasound
 USUALLY URGENTLY REQUIRED
ECG
 If > 40 or any risk factors for cardiac disease
Pulmonary function   in systemic disease, acutely and after recovery
Immunoglobulins, prot elect   in most patients
Complement   in almost all
ANF, etc   and DNA antibodies if ANF positive
ENA   if suspect interstitial nephritis or atypical SLE
Rheumatoid factor    
ANCA   all possibly inflammatory disease
Anti-GBM   all possible RPGN
Cryoglobulins   if C4 low or otherwise indicated

 

Acknowledgements:   Neil Turner, David Kluth and John Neary were the main authors for this page. The last modified date is shown in the footer.

 

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