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Renal Insufficiency

Haroon Samar, MD, MPH and Zachary Prather, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

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

  • It is defined by the rise in serum creatinin...

DIAGNOSIS

HISTORY

  • In addition to history of renal, cardiac, hepatic, and systemic disease, inquiring about use of renal toxic medications is an excellent starting point.

  • Most patients with mild to moder...

TREATMENT

GENERAL MEASURES

  • Patients with mild renal insufficiency with a known reversible cause can be managed in an outpatient setting.

  • Essential in managing AKI is determining volume status and adequa...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

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

REFERENCES

1
Chawla LS, Eggers PW, Star RA, et al. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med.  2014;371(1):58–66. [View Abstract on OvidMedline]
2
Rahm...

CODES

ICD10

  • N28.9 Disorder of kidney and ureter, unspecified

  • N18.9 Chronic kidney disease, unspecified

ICD9

  • 593.9 Unspecified disorder of kidney and ureter

  • 585.9 Chronic kidney disease, unspecified

SNOMED

  • 42...

CLINICAL PEARLS

  • AKI predisposes a patient to development of CKD.

  • Treatment of AKI focuses on reversing the cause of decreased GFR such as improving hypovolemia through intravenous fluid resuscitation, ...

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