First Step In Evaluation Of Acute Renal Failure

History

Disorders that suggest or predispose to renal failure: hypertension, diabetes mellitus, human immunodeficiency virus, vascular disease, abnormal urinalyses, family history of renal disease, medication use, toxin or environmental exposure, infection, heart failure, vasculitis, cancer

Disorders that suggest or predispose to volume depletion: vomiting, diarrhea, pancreatitis, gastrointestinal bleeding, burns, heat stroke, fever, uncontrolled diabetes mellitus, diuretic use, orthostatic hypotension, nothing-by-mouth status, nasogastric suctioning Disorders that suggest or predispose to obstruction: stream abnormalities, nocturia, anti-cholingeric medications, stones, urinary tract infections, bladder or prostate disease, intra-abnominal malignancy, suprapubic or flank pain, anuria, fluctuating urine volumes Symptoms of renal failure: anorexia, vomiting, reversed sleep pattern, puritus

Record review Recent events (procedures, surgery) Medications (see Fig. 12-22) Vital signs Intake and output Body weights

Blood chemistries and hemogram

Physical examination

Skin: rash suggestive of allergy, palpable purpura of vasculitis, livedo reticularis and digital infarctions suggesting atheroemboli Eyes: hypertension, diabetes mellitus, Hollenhorst plaques, vasculitis, candidemia Lungs: rales, rubs

Heart: evidence of heart failure, pericardial disease, jugular venous pressure

Vascular system: bruits, pulses, abdominal aortic aneurysm

Abdomen: flank or suprapubic masses, ascites, costovertebral angle pain

Extremities:edema, pulses, compartment syndromes

Nervous system: focal findings, asterixis, mini-mental status examination

Consider bladder catheterization

Urinalysis (see Fig. 12-13)

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