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Surgical sieve
💧 AKI / oliguria
Pre-renal, renal, or post-renal? Scan the bladder and review the drug chart first.
| Hypovolaemia / pre-renal Time-sensitive | Dry mucous membranes, flat JVP, tachycardia, postural drop. The commonest cause.Fluid challenge 250–500ml and reassess. |
|---|---|
| Sepsis Must exclude | AKI is frequently the first sign of sepsis.Septic screen, Sepsis 6. |
| Urinary obstruction Must exclude | Anuria, palpable bladder, prostatic symptoms, single kidney.BLADDER SCAN — the first thing to do in any AKI. Catheterise if retained. |
| Nephrotoxic drugs Time-sensitive | NSAIDs, ACE inhibitors/ARBs, aminoglycosides, contrast, diuretics.Review and stop the nephrotoxic triad. Check gentamicin levels. |
| Cardiorenal / heart failure Time-sensitive | Fluid overloaded rather than dry — raised JVP, oedema, crepitations.Fluids would worsen this — assess volume status carefully. |
| Rhabdomyolysis Time-sensitive | Long lie, crush, seizures, statins. Dark urine, dipstick blood with no red cells.CK, U&Es, aggressive fluids, watch potassium. |
| Hepatorenal syndrome Time-sensitive | Decompensated liver disease, ascites, no other cause found. |
| Glomerulonephritis / vasculitis Time-sensitive | Haematuria and proteinuria, red cell casts, rash, haemoptysis.Urine dip and microscopy, immunology screen, renal referral. |
| Contrast nephropathy Common | 48–72h after contrast. Higher risk in CKD and diabetes. |
| Myeloma / hypercalcaemia Consider | Bone pain, anaemia, hypercalcaemia, raised ESR in an older patient.Calcium, protein electrophoresis, light chains. |
10 differentials · 9 open a full pathway in the app.