Basics of the Management of Acute Renal Failure and its Complications for the General Physician

Clinical evaluation is the first step in the management of acute kidney injury (AKI). Complications of AKI include pulmonary edema from fluid overload, tachypnoea from acidosis or fluid overload, indications of encephalopathy, such as seizures, and pericardial rub. Before standard laboratory blood findings are available to check for hyperkalemia and degree of acidity, venous blood gas (or arterial if hypoxic) is urgently needed. In order to monitor for complications and potential causes of acute kidney injury (AKI), a clinical examination is necessary. This includes looking for signs of sepsis or shock, which call for immediate management using the sepsis six bundle, palpating the bladder to rule out obstruction, considering the use of a urinary catheter even in the absence of obstruction to aid in urine output (UO) monitoring, and determining whether active sediment (proteinuria and hematuria) is present in the urine dipstick.