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Acute Kidney Injury (AKI) and

Renal Assessment

Introduction

Acute kidney injury (AKI), nephrotic syndrome, nephritic syndrome, the various glomerulonephritides, chronic kidney disease (CKD) and so on – it is easy to be lost in the maze of nephrology if you do not know where you are going.

Where do you start? How can you tell what is important and what isn’t? The Hands-on Guide to Clinical Reasoning in Medicine will guide you every step of the way in getting you out of this maze.

It has been written keeping its audience in mind, simplifying nephrology and all other medical specialties by focussing on the important facts. It has been presented in a fun, easy to understand, easy to use, practical, hands-on style for students, junior doctors and nurse practitioners.

History taking, renal clinical examination, investigations, common presentations… we have it all covered.

For instance, have you ever considered that the clinical examination in AKI needs to elicit just three elements? Namely,

  1. Cause of the renal failure
  2. Effects of renal failure
  3. Need for renal replacement therapy

Topics covered include:

1. History taking

Concept maps and figures illustrate all the common symptoms in nephrology like haematuria, polyuria, oliguria, AKI and CKD.  Figures show the symptom aetiology superimposed on the traditional model of pre-renal, renal and post-renal causes. Self-explanatory anatomical or pathophysiological models are used which makes learning easy.

Non-specific symptoms of AKI are also summarised in an easy to read concept map that synthesises all the relevant information in a snapshot. With these highly visual representations by your side, you will never have to memorise long lists anymore!

Figure 1 shows this in action for AKI.

Figure 1

Credit source: Irfan M, Hands-on Guide to clinical Reasoning in Medicine, Wiley-Blackwell; 1 edition (1 Feb. 2019)

Acute Kidney Injury (AKI)
Clinical examination in AKI

2. Clinical examination

Clinical examination in nephrology often involves examining other systems outside the abdomen. Tests often precede examination. In fact, test results commonly direct you to approach history and examination in a more focused manner. There is a constant forward and backward processing of information that helps you arrive at the diagnosis.

Want to know how to examine a transplanted kidney? We’ve got it covered.

How do you distinguish a renal mass from splenomegaly? Yep, and that.

What do you look for in AKI? We have that too!

It’s just those three elements mentioned before – cause of renal failure, effects of renal failure and need for renal replacement therapy. All beautifully illustrated in concept maps.

Clinical examination in CKD goes a step further and teaches how to look for signs of treatment. All this is can be gleaned from examination alone, in a true ‘Sherlock Holmes’ style (or ‘House’ whichever you prefer)!

3. Investigations

Urine dipstick interpretation, one of the most basic tests is dealt with in a concise manner directing you to the most important aspects, cutting all the waffle. A concept map shows how different elements in a dipstick test combine to lead you to the diagnosis.

Did you know that symptoms in renal failure are the last thing to occur in the path of nephron destruction? Hypertension and active urinary sediment are the first, followed by a drop in the glomerular filtration rate, then a rise in a creatinine and finally symptoms. All of this is shown in a highly visual format that sticks in your brain.

Acid-base balance, another bane in the lives of many a medical student is explained in simple language and a figure. A high anionic gap just implies that there are more unmeasured anions in the blood. What are these anions? KUSSMAUL gives you the answer. GOLD MARK a 21st century mnemonic takes it a step further (Mehta et al., 2008). The tabs in figure 2 give you the details.

Figure 2: Mnemonics For Raised Anion Gap

4. Clinical Presentations

  • Hypertension
  • Oedema
  • Haematuria
  • Non-specific symptoms

Engaging dialogues in an apprenticeship model teach you how to arrive at the relevant diagnoses in a workbook format in no time. Plenty of concept maps and figures carry you through the process with ease. In short you will have a teacher albeit in spirit, by your side, guiding you every step of the way.

Ready for a helping hand? You can find out all about the neurology exam right now and buy the Hands-on Guide to Clinical Reasoning in Medicine here.

Not quite sure yet?

See all the other topics here..

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