The differential diagnosis includes atheroembolic renal failure, acute renal failure, acute interstitial nephritis, and acute tubular necrosis.

• Acute tubular necrosis:a medical condition involving the death of tubular cells that form the tubule and transports urine to the ureters. the occurrence of Ischemia can be from endogenous toxins, such as free hemoglobin or myoglobin, or from exogenous toxins, such as antibiotics, chemotherapeutic agents, and heavy metals

• Atheroembolic renal failure: which usually occur after 7 days of contrast exposure with a prolonged course. Manifestation of thromboembolism include blue toes and Livedoid vasculitis,which is due to embolism induced obstruction of capillaries. Transient eosinophilia have been associated with thromboembolism.

• Acute renal failure: causes are numerous and include low blood volume from any cause, exposure to substances harmful to the kidney, and obstruction of the urinary tract. AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine. acute renal failure is usually oliguric, and recovery occur in 2-3 weeks.

• Acute interstitial nephritis: this disease can be either acute or chronic. Chronic cases eventually ending in kidney failure. Manifestations include fever, skin rash, eosinophilia, and eosinophiluria.

• Acute tubular necrosis– a medical condition involving the death of tubular cells that form the tubule and transports urine to the ureters. the occurrence of Ischemia can be from endogenous toxins, such as free hemoglobin or myoglobin, and light chains, or from exogenous toxins, such as antibiotics, chemotherapeutic agents, organic solvents, and heavy metals