this presentation contains the most used methods for distinction between pre-renal and renal causes of AKI.

1. Clinical vignette VIII
Multi-organ failure
Reem Alyahya
212522156

2. introduction
Mona
Acute
abdominal
pain
Resuscitated
Day3:
deteriorated

3. Objective
 How to differentiate between renal and
pre-renal causes of AKI?

4. Acute kidney injury
 Abrupt deterioration in parenchymal renal
function, which is usually reversible over a
period of days or week.

5. Classification
Pre-
renal
Renal
Post-
renal

6. Pre- renal :
 In pre-renal uremia, there is impaired blood
perfusion to the kidneys. Usually the kidney is able
to maintain GF close to normal despite wide
variation in renal perfusion.
 The most common form of AKI

7. Causes include:
Volume depletion
Decreased
cardiac output
Systemic
vasodilatation
Renal
vasoconstriction
Drugs like NSAIDs
and ACEI

8. Renal :
 Structural injury in the kidney is the hallmark of
renal AKI , it’s the second most common form of
AKI after pre-renal causes.
 And its most commonly due to acute tubular
necrosis (ATN)

9. Causes include:
Diseases
involving
renal
vessels
Glomerul-
onephritis
Tubular
(ischemic ,
nephrotoxic)
Interstitial

10. How to differentiate?

11. History
Physical
examination
Laboratory
criteria

12. History
Pre-renal
 Volume loss
 Heart failure
 sepsis
 Drug use
Renal
 Prolonged hypotension or
hypovolemia
 Nephrotoxic drugs
 Symptoms GN

13. Physical examination
Pre-renal
 tachycardia
 Low JVP
 Systemic/orthostatic
hypotension
 Manifestations of
hypovolemia
 Clinical picture of Heart
failure.
Renal
 Manifestations GN
 Manifestations of vascular
or interstitial disease

14. Laboratory criteria

15. conclusion
 AKI is an abrupt deterioration in parenchymal renal
function, which is usually reversible.
 The causes can be classified into: pre-renal, renal and
post-renal
 We can differentiate between these forms by the way of
: history, physical examination and laboratory criteria.

16. Reference
 Kumar p, Clark M. Clinical medicine. Eighth edition. 2012

17. Thank you
Any questions?