Typical exam stem
A hospitalised patient develops oliguria and a rapidly rising creatinine. How would you assess and manage the AKI?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What are the three broad categories of AKI?
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Recognise AKI early
AKI is identified by an acute rise in serum creatinine, a fall in urine output, or both. The first exam task is to identify reversible threats while simultaneously assessing complications. Ask whether the problem is reduced renal perfusion, intrinsic renal injury or urinary obstruction.
Bedside cause-finding
- Review blood pressure, volume status, fluid losses, sepsis and cardiac function.
- Review nephrotoxins and recent contrast exposure.
- Urinalysis can reveal blood, protein, leucocytes or other clues to intrinsic renal disease.
- Bladder assessment and renal tract imaging are important when obstruction is possible.
- Look for systemic clues to glomerulonephritis, vasculitis, rhabdomyolysis or interstitial nephritis when appropriate.
Management
Treat the cause, optimise haemodynamics, stop or adjust nephrotoxic medicines and dose other medicines for current renal function. Fluids are useful when true hypovolaemia is present but can be harmful when congestion or heart failure is the dominant problem.
Monitor urine output, creatinine, potassium, acid-base status and fluid balance. Escalate early for refractory hyperkalaemia, severe acidosis, pulmonary oedema, uraemic complications or other indications for kidney replacement therapy.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.