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Renal Insufficiency

Arturas Klugas, MD, FAAFP and Egle Klugiene, DipABLM, MD Reviewed 04/2024
 


BASICS

DESCRIPTION

  • Renal insufficiency is deterioration of kidney function secondary to an acute kidney injury (AKI) or chronic kidney disease (CKD).

  • Stages of AKI are based on serum creatinine (Cr) lev...

DIAGNOSIS

HISTORY

  • In addition to history of renal, cardiac, hepatic, and systemic disease, inquire about the use of nephrotoxic medications.

  • Most patients with mild to moderate renal insufficiency may b...

TREATMENT

GENERAL MEASURES

  • Adequate perfusion of kidneys is essential in managing AKI. If fluid resuscitation is needed, crystalloids are preferred over colloids (1). 

  • Electrolyte abnormalities should ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Regardless of presence of hypertension, patients with diabetic kidney disease and nondiabetic CKD with urine protein-to-creatinine ratio >200 mg/g should be tr...

REFERENCES

1
Kidney International Supplements Work Group. KDIGO Clinical Practice Guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1).
2
Levey AS, James MT. Acute kidney injury. Ann Intern Med...

SEE ALSOICD10 CODES

  • N17.9 Acute kidney injury, unspecified

  • N18.1 Chronic kidney disease, stage 1

  • N18.2 Chronic kidney disease, stage 2

  • N18.3 Chronic kidney disease, stage 3

  • N18.4 Chronic kidney disease, s...

CODES

ICD10

  • N28.9 Disorder of kidney and ureter, unspecified

  • N18.9 Chronic kidney disease, unspecified

SNOMED

  • 42399005 Renal failure syndrome

CLINICAL PEARLS

  • Treatment of AKI focuses on reversing the cause such as improving hypovolemia, discontinuing potential nephrotoxins, and reversing ureteral obstruction, if present.

  • The foremost cause o...

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