Summary of differential features in the evaluation of acute renal failure

Oliguric acute Acute

Assessment Prerenal azotemia tubular necrosis glomerulonephritis Acute interstitial Atheroembolic Obstruction
Clinical Hypovolemia or fall in Ischemia + nephrotoxin Sometimes anuria Drug history, rash Widespread Pain (if acute), anuria
effective extracellular vasulopathy
fluid volume
Blood urea nitrogen >20:1 10-15:1 10-15:1 10-15:1 10-15:1 >20:1
a
(BUN): creatinine ratio
Urine Na+ <10 >40 <10 Variable >40 <20 (early),
[mg/dL (mmol/L)] >40 (late)
Urinalysis Normal Muddy brown casts Heavy hematuria Hematuria, proteinuria, Normal Normal
heavy proteinuria, white blood cells and
red blood cell casts casts, eosinophiluria
Urine osmolality >500 <350 Variable Variable <350 Raised early
(mosmol) lowered late
Ultrasound size Normal Normal Normal or enlarged Normal Normal or shrunken Pelvicalyceal dilation