This document outlines protocols for admission of patients from the emergency room to the nephrology department. It provides guidelines for workup of patients in the ER by nephrologists, including history, vital signs, imaging, labs, and life-saving measures. Cases that should be admitted to nephrology include those requiring emergency hemodialysis, severe uremic manifestations, volume overload, or access failure. Acute kidney injury patients meeting RIFLE criteria for risk, injury, or failure should also be admitted for water/electrolyte management and follow up to assess need for hemodialysis.

1. Ministry of Health
Dakahlia Medical diroctorate
New Mansoura General Hospital
Nephrology Department
Dr. Osama El Shahat
Consultant of Nephrology
Dr. Wael Ramadan
Head of nephrology department
New Mansoura General Hospital
Resident of nephrology
New Mansoura General Hospital
Protocol Of Admission From
emergency room ( ER )

2. A)EMERGENCY ROOM WORK UP:
These items have to be fulfilled by nephrologists
responsible for ER:-
1-full history of the patient with focusing on the complaint.
2-vital signs: blood pressure, pulse, temperature and respiratory
rate.
3-abdominal ultrasound.
4-CBC,s.creatinine ,blood urea ,s.K ,s.Na ,ABG and INR.
5-Chest x-ray is mandatory in case of dyspnea.
6-ECG if arrhythmia or IHD is suspected to be the cause of
dyspnea or chest pain.
7-Start life saving measures as needed in ER (e.g antihyperkalemic
measures ).
8-referal to other specialities.
9-Complete the admission file by the same responsible
nephrologist in ER.
B)CASES TO BE ADMITTED TO NEPHROLOGY DEPARTMENT:
1-Emergency Hdx:
a)when Hdx is life saving : pulmonary oedema ,severe metabolic
acidosis(caused by renal failure),hyperkalemia and ureamic
coma.
b)severe ureamic manifestations(e.g pericardial or pleural effusion,
recurrent vomiting, etc.) requiring start of regular Hdx.
c) severe volume overload.
d)central cath insertion for access failure in Hdx patients.
e)please overview protocol of Hdx.

3. 2-AKI patients:
a)R,I and F stages of AKI according to RIFLE criteria should be
admitted.
b)Exceptions include postrenal causes ,hepatorenal syndrome
,cardiorenal syndrome and heamodynamically unstable patients.
c)Aim of admission is restoring water and electrolyte hemostasis
,correction of the cause and follow up to assess need for Hdx.
d)cases with raised s. creatinine that is not evident to be acute
should be referred to nephrology clinic unless in need for
emergency Hdx
RIFLE
criteria
S. creatinine Urine output
RISK S.cr > 1.5 x baseline UOP < 0.5ml/kg/h x 6h.
INJURY S.cr > 2 x baseline UOP < 0.5ml/kg/h x 12h.
FAILURE S.cr >than 3 x baseline Or S.cr > 4mg/dl
UOP < 0.3ml/kg/h x 24h Or
anuria x 12h.
LOSS Complete loss of function > 4 weeks
ESRD ESRD > 3 months