
Health Dictionary
Reliable, easy-to-read patient information on common medical conditions β written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Acute kidney injury differential diagnosis
Introduction

Overview
Overview
AKI typically results in oliguria. AKI should be differentiated on the basis of underlying etiology.
Differentiating AKI from other Diseases
Differentiating AKI from other Diseases
AKI typically results in oliguria. AKI should be differentiated on the basis of underlying etiology.
Abbreviations: ABG = Arterial blood gases, BUN = Blood urea nitrogen, CBC = Complete blood count, CT = Computed tomography, CRP = C – reactive protein, ECG = Electrocardiogram, ESR = Erythrocyte sedimentation rate, IVP = Intravenous pyelography, KFT = Kidney function test, GI = Gastrointestinal, GFR = Glomerular filtration rate, MRI = Magnetic resonance imaging, PT = Prothrombin time
| Etiology | Clinical manifestations | Paraclinical findings | Comments | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms and signs | Lab findings | Imaging | ||||||||||||||||||||
| Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | |||
| Prerenal causes | Alcohol poisoning[1][2] | + | – | +/- | – | +/- | + | +/- | – | – | βPT | βBUN, βCr (isopropyl alcohol) | βNa | NA | βHCO3 | LFT | NA | NA | NA | NA | – | Administer thiamine to prevent Wernicke’s encephalopathy |
| Aspergillosis[3][4] | +/- | – | – | – | – | – | – | +/- | – | NA | NA | NA | NA | NA | Allergy test, βIgE (>1000 IU/dl), direct visualization of fungal hyphae | NA | Pulmonary infiltrates, mucus plug, mass in the upper lobe surrounded by a crescent of air, solitary or multiple cavities | Halo sign, wedge-shaped pulmonary infarction, granuloma | NA | – | Polymerase chain reaction (PCR) confirms the diagnosis | |
| Cholera[5][6][6][7] | +/- | + | +/-
Depends on severity |
– | – | +/- | + | – | – | Leukocytosis, βHCT | βBUN, βCr | βNa, βCa, βMg | NA | βLactate, βHCO3 | Stool PCR, stool culture, serotyping | NA | NA | NA | NA | – | – | |
| Congestive heart failure (CHF)[8][9] | + | – | – | – | – | – | + | – | + | Anemia, leukocytosis | βBUN, βCr | βNa, βK | NA | βLactate, βHCO3, | βBNP, βtroponin | Cardiomegaly, pulmonary hypertension, pleural effusion | Pulmonary edema | NA | Valvular heart disease | Decreased ejection fraction in echocardiography, decreased heart function and damage in nuclear imaging | – | |
| Dehydration[10][11] | + | + | +/-
Depends on the severity |
+/- | – | +/- | +/- | – | – | NA | βBUN, βCr | βNa, βK, βCl | β Urine ketones and glucose, βurine specific gravity | βLactate, βHCO3 | Hypoglycemia | NA | NA | NA | NA | – | – | |
| Diarrhea and/or vomiting[12][13] | +/- | +/- | – | – | – | + | + | – | – | Leukocytosis with predominant neutrophilia, βESR | NA | NA | β Urine ketones, organic acids, porphobilinogen, aminolevulinic acid | NA | Stool anion gap, stool pH < 5.5, stool culture, serotyping, enzyme immunoassay (rotavirus or adenovirus), abnormal LFT, amylase, lipase | Normal | NA | NA | NA | – | – | |
| Etiology | Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | Comments | |
| Drugs/toxins[14][15] | +/- | +/- | +/- | +/- | +/- | +/- | +/- | +/- | +/- | NA | βBUN, βCr, βCK | βK, βMg, βCa, βP | Ingested drug, glucose, aminoacid, phosphate, ketone, hyaline cast, and RBC | βLactate, metabolic acidosis | Toxicology, rapid immunoassay | Nephropathy | Radioopaque substances, ingested drug packets | NA | NA | – | – | |
| Esophageal varices bleeding[16][17] | +/- | – | – | – | +/- | – | – | – | – | Normocytic normochromic anemia | βBUN, βCr | NA | NA | NA | NA | Velocity and direction of portal flow | Abnormal opacities outside ofesophageal wall, posterior mediastinal or intraparenchymal mass, dilated azygous vein | Entire portal venous system | Portrays esophageal varices as flow voids | Portal hypertension and esophageal varices in positron emission tomography, flexible endoscope, barium swallow of snake-like filling defects | – | |
| Congenital heart disease[18][19] | +/- | – | – | – | – | – | – | +/- | +/- | βESR and CRP | βBUN, βCr | NA | NA | NA | Throat culture, rapid streptococcal antigen test, hyperoxia test, pulse oximetry | NA | Cardiomegaly, dextrocardia | NA | NA | Ventricular dysfunction, left and right ventricular hypertrophy, valvular disease in echocardiography | – | |
| Hemorrhage[20][21] | – | + | +/-
Depends on the severity |
– | – | – | – | +/- | – | Normocytic normochromic anemia, βPT, βPTT | βBUN, βCr | βNa, βCl, βCa | NA | Metabolic acidosis | NA | Peritoneal cavity fluid in FAST | Bilateral opacities in the lung field, hemothorax, hemoperitoneum, ruptured abdominal aortic aneurysm | Intrathoracic, intra-abdominal, and retroperitoneal bleeding | NA | Source of bleeding in the upper GI in EGD, angiography | – | |
| Hemolysis[22][23] | +/- | – | – | – | – | – | – | +/- | – | Thrombocytopenia, microcytic hypochromic anemia, βRDW, βretic count | NA | NA | NA | NA | βLDH, βhaptoglobin, βunconjugated bilirubin | Hepatomegaly, splenomegaly | NA | NA | NA | – | – | |
| Etiology | Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | Comments | |
| Hepatorenal syndrome[24][25] | +/- | – | – | – | +/- | +/- | – | – | +/- | Leukocytosis, βPT | βGFR, βBUN, βCr | βNa | Proteinuria, Na <10mEq/L, urine osmolality > plasma osmolality | NA | Alpha feto-protein, cryoglobulinemia | Exclude hydronephrosis and intrinsic renal disease | NA | NA | NA | Right ventricular preload, ventricular filling pressures, and cardiac function in echocardiography | – | |
| Ischemic cardiomyopathy[26][27] | +/- | – | – | – | – | – | – | +/- | +/- | Anemia | βCr | βNa, βK, βMg | NA | NA | Troponin, creatine kinase, Creatine kinase-MB, BNP | NA | Abnormal cardiac silhouette | Biventricular volume, wall motion abnormality, myocardial perfusion, hypertrophic cardiomyopathy | Mid-wall fibrosis in MRI | Ejection fraction β€35%, pulmonary embolism, right ventricular dilation or pericardial effusion with tamponade in echocardiography | – | |
| Liver cirrhosis[28][29] | +/- | – | +/- | +/- | +/- | – | – | – | +/- | NA | NA | NA | NA | NA | Abnormal LFT, aspartate aminotransferase to platelet ratio, FibroTest/FibroSure, Hepascore | Portal blood flow velocity, hepatic artery enlargement, multifocal lesions or masses, hepatic contour, ascites, splenomegaly | Bowel perforation, gynecomastia, azygos vein enlargement, pleural effusion | Morphologic changes in the liver, collaterals and shunts, hyperattenuating nodule of hepatocellular carcinoma, portal vein thrombosis | Vacular patency, tumor invasion, portal vein thrombosis, steatosis | Hepatic function and portal hypertension in nuclear imaging, hepatic perfusion and the development of shunts and tumors in angiography | Irreversible and a transplant is usually needed | |
| Malignant hypertension[30][31] | +/- | – | + | – | – | +/- | – | +/- | +/- | Microangiopathic hemolytic anemia | βBUN, βCr | βNa, βK, βP | Proteinuria, microscopic hematuria | Acidosis | Cardiac enzymes, urinary catecholamines, TSH, βRenin | NA | Cardiomegaly, pulmonary edema, rib notching, aortic coarctation, mediastinal widening, aortic dissection | NA | NA | Left atrial enlargement and left ventricular hypertrophy in echocardiography | – | |
| Etiology | Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | Comments | |
| Myocarditis[32] | +/- | – | – | – | +/- | – | – | +/- | – | Leukocytosis (eosinophilia),βESR and βCRP | NA | NA | NA | NA | Cardiac enzymes, viral antibodies | NA | NA | NA | Inflammatory edema, degree of scarring | Endomyocardial biopsy, echocardiography, scintigraphy | NA | |
| Peritonitis[33][34] | +/- | – | +/- | – | +/- | +/- | +/- | – | – | Leukocytosis | NA | NA | NA | NA | Ascitic fluid neutrophil count > 500 cells/Β΅L | NA | NA | NA | NA | – | – | |
| Polycythemia[35][36] | +/- | – | – | – | – | – | – | +/- | – | βRBC, βHCT, βHGB, thrombocytosis, leukocytosis, βPT, and βaPTT | βErythropoietin | NA | NA | NA | Hyperuricemia | Splenomegaly | NA | NA | NA | – | Phlebotomy is the usual treatment | |
| Respiratory distress syndrome[37] | + | – | +/- | – | – | – | – | + | – | NA | NA | NA | NA | Metabolic and respiratory acidosis | Pulse oximetry | NA | Bilateral, diffuse, reticular granular or ground-glass appearance +/- cardiomegaly | NA | NA | Patent ductus arteriosus in echocardiography | – | |
| Shock[38] | +/- | +/- | +/- | +/- | +/- | +/- | – | +/- | – | βHCT, βPT and aPTT, Eosinophilia, Leukocytosis | βGFR, βBUN, βCr | NA | NA | βLactate | LFT, βBNP, βtroponin, D-dimer, fibrinogen | Pulmonary embolism, pericardial effusion, cardiac tamponade, pneumothorax, thoracic or abdominal aortic aneurysm in RUSH (Rapid Ultrasound for Shock and Hypotension) | Pneumonia, pneumothorax, pulmonary edema, widened mediastinum, free air under the diaphragm | Traumatic brain injury, stroke, spinal injury, pneumonia, pPneumothorax, ruptured aneurysm, aortic dissection, pulmonary embolism | NA | – | – | |
| Toxic megacolon[39] | +/- | +/- | +/- | – | + | + | +/- | – | – | Leukocytosis, anemia, βESR and βCRP | βBUN, βCr | βNa | NA | NA | Loss of haustra, hypoechoic and thick bowel walls, dilated colon > 6cm, dilatation of ileal loops | Dilated colon, free intraperitoneal air | Bowel perforation, abscess | NA | NA | Endoscopy and colonoscopy | – | |
| Etiology | Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | Comments | |
| Renal causes | Acute interstitial nephritis[40][41] | +/- | – | +/- | – | +/- | +/- | +/- | +/- | +/- | Eosinophilia | βBUN, βCr, βFENa | NA | Eosinophiluria, sterile pyuria, mMicroscopic hematuria, proteinuria | NA | βTotal IgG, βIgG4 | Normal-sized kidneys | NA | NA | NA | – | History of long term analgesic use |
| Acute tubular necrosis[42][43] | +/- | – | – | – | – | +/- | – | – | +/- | Anemia | βBUN, βCr, βFENa | βNa, βK, βMg, βP, βCa | Pigmented, muddy brown, granular casts | NA | NA | Obstructive uropathy, cortical thickness, hydronephrosis | Nephrolithiasis | Nephrolithiasis, area of obstruction | Nephrolithiasis, area of obstruction | Loss of tubular cells or the denuded tubules, swollen tubular cells, lLoss of the cell brush border in renal biopsy | Furosemide stress testing for staging | |
| Cancer[44][45] | + | – | – | – | +/- | +/- | – | – | +/- | Normocytic or microcytic anemia, leukocytosis or lymphocytosis, βreticulocytes, thrombocytopenia | βGFR, βBUN, βCr, βErythropoietin | βNa, βK, βMg, βP, βCa | Gross hematuria | NA | LFT | Fluid collection and morphological change, flank mass | Calcification and widened mediastinum, filling defects in barium contrast | Metastasis and staging, cystic and solid masses, lymph node, renal vein, and inferior vena cava involvement | Soft tissue invasion and staging | Malignant cystic lesions percutaneous cyst puncture | Renal cell carcinoma types: Clear cell (75%), chromophilic (15%), chromophobic (5%), oncocytoma (3%), collecting duct (2%) | |
| Congenital kidney disease[46][47][48]
– Agenesis |
+/- | – | – | – | +/- | +/- | – | – | +/- | βHCT | βGFR | βP, βCa | Microalbuminuria, uricosuria | NA | Genetic testing forADPKD2 | Visualization of kidney cysts | Small kidney cysts (0.5 cm) | Kidney size, intracranial aneurysms | NA | – | – | |
| End stage renal disease[49][50] | + | – | – | – | +/- | – | – | – | + | Anemia | βGFR, βBUN, βCr | βK | Hypoalbuminuria | βHCO3 | Phosphate, 25-hydroxy vitamin D, alkaline phosphatase, parathyroid hormone | Hydronephrosis, retroperitoneal fibrosis, enlarged or shrunken kidneys | Obstruction in retrograde pyelogram | Renal masses, stones, and cysts | Renal vein thrombosis, renal artery stenosis in magnetic resonance angiography | Percutaneous renal biopsy | – | |
| Etiology | Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | Comments | |
| Endogenous toxins[51][52][53][54][55] | +/- | – | +/- | + | – | +/- | – | – | +/- | Anemia, thrombocytopenia | βGFR, βBUN, βCr | βK, βurate, βCa | Uricosuria, hematuria, myoglobinuria, casts | NA | Creatine kinase > 1000 U/L | Malignant or cystic lesions, hydronephrosis, nephrocalcinosis, urolithiasis | NA | Urolithiasis, wilms tumor, polycystic kidney disease | NA | Ureter or bladder abnormality in voiding cystourethrography | – | |
| Glomerulonephritis[56][57][58] | +/- | – | – | – | – | – | – | – | + | Pleocytosis, anemia, leukocytosis, βESR | βBUN, βCr | NA | Specific gravity > 1.020, proteinuria, hematuria, red blood cell casts, white blood cell casts, cellular casts, oval fat bodies | NA | NA | βC3, βC4, βCH50, blood and tissue culture, antinuclear antibodies, cryoglobulins, hepatitis B and C serologies, antineutrophil cytoplasmic antibody (ANCA) | Kidney size, echogenicity of the renal cortex, obstruction, degree of fibrosis | Pulmonary congestion | Visceral abscesses | – | Renal biopsy, light and electron microscopy, immunofluorescence aid diagnosis | |
| Goodpasture syndrome[59][60][61] | +/- | – | – | – | – | – | – | +/- | +/- | Anemia, leukocytosis, βESR | βBUN, βCr | NA | Low-grade proteinuria, gross or microscopic hematuria, RBC casts | NA | Antiβ glomerular basement membrane antibody, antineutrophilic cytoplasmic antibody | NA | Bilateral, basal, patchy parenchymal consolidations | NA | NA | Diffuse alveolar hemorrhage in pulmonary biopsy | – | |
| Hemolytic uremic syndrome[62][63][64] | +/- | – | +/- | +/- | +/- | + | + | – | +/- | Severe anemia, thrombocytopenia, βaPTT | βBUN, βCr | NA | Mild proteinuria, Red blood cells, Red blood cell casts | NA | Schistocytes, βFDP and D-dimer, βbilirubin, βLDH, βhaptoglobin, stool culture (for E coli 0157:H7 or shigella), βADAMTS-13 activity | Ruling out obstruction | NA | NA | NA | Diffuse thickening of the glomerular capillary wall, swelling of endothelial cells, fibrin thrombi in renal biopsy | – | |
| Nephrolithiasis[65][66][67] | – | – | – | – | +/- | +/- | – | – | – | Mild leukocytosis, βCRP | βBUN, βCr | βNa, βK, βP, βCa, βurate | Gross or microscopic hematuria, Red blood cells, urinary crystals of calcium oxalate, uric acid, or cystine, hypercalciuria, urinary pH > 7 in struvite stones (Proteus, Pseudomonas, Klebsiella), urinary pH < 5 in uric acid stones | βHCO3, renal tubular acidosis | – | All types of stones are visible, hydronephrosis, abdominal aortic aneurysm, cholelithiasis | Calcium – containing stones, uric acid or cystine stones, stone movement | Stone density, size and composition, hydronephrosis, nephromegaly, perinephric fat streaking | NA | Intravenous pyelography (IVP), renal tomography, nuclear renal scan | – | |
| Etiology | Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | Comments | |
References
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2], Eiman Ghaffarpasand, M.D. [3], Anmol Pitliya, M.B.B.S. M.D.[4]
