Pre-renal: Hypovolemia, anemia.

Renal: Drug toxicity [eg, NSAIDs (Am J Epidem 2000;151:488)—even topical (BMJ 2000;320:93)] and salicylates and acetaminophen possibly implicated in chronic renal failure (CRF) (Nejm 2001;345:1801); acute tubular necrosis (ATN)—as seen in shock, crush injuries, hypothermia, heavy metal toxicity, snake venom toxicity, organic solvent toxicity, intravascular hemolysis; rhabdomyolysis from drug abuse, such as ethanol, iv heroin, and more recently iv temazepam (Qjm 2000;93:29) or wild mushroom intoxication (Nejm 2001;345:798); iv dye reaction in those with underlying renal insufficiency; multiple myeloma (Nephron 2000;85:96); HIV with many etiologies such as interstitial nephritis (Am J Kidney Dis 2000;35:557).

Post-renal: Obstruction.

Uremia may lead to sallow skin, pericardial effusion.

X-ray: Renal US.

Calculating Creatinine Clearance (CrCl or C_Cr) (Nephron 1976;16:31):

Hold all potentially offending drugs; place indwelling catheter.

Consider iv fluid bolus for hypovolemia (Drugs 2000;59:79), correction of anemia.

Trial of α-blocker Alfuzosin 10 mg/d for 3 d with catheter removal after two doses and one additional dose after catheter removal with an odds ratio for success almost 2, with failures seen with older age (> 65 yr of age) and higher initial retention volumes (> 1000 ml)—this was studied in those with BPH (J Urol 2004;171:2316).

Treat underlying arrhythmias/hyperkalemia, as warranted.

Thyroxine of no help in euthyroid patients (Kidney Int 2000;57:293).

Dialysis to prevent complications and death (Kidney Int 1972;1:190), better with daily treatment (Nejm 2002;346:305).

Hydration with 154 mEq/L of sodium bicarbonate with a 3 cc/kg bolus 1 hr before the procedure and follow this with 1 cc/kg per hr for 6 hr after the procedure to decrease the incidence of contrast-induced nephropathy from 13.6% to 1.7% when comparing against NS (same volumes) (Jama 2004;291:2328)—whether this translates into treatment of actual clinical disease is debatable.

Acetylcysteine 600 mg po bid × 2 d prior to procedure with iv dye in those with moderate CRF (Jama 2003;289:553)—same caveat as to whether this prevents actual clinical disease.

Perhaps use iso-osmolar dimeric, nonionic contrast (iodixanol) in those who need iv dye (Nejm 2003;348:491).

Folate deficiency (BMJ 1969;2:18)

EKG artifacts from fistula/cannula arm

Pericarditis (Am J Med 1977;63:874)

Pneumonia, atelectasis, and pleural effusion from CAPD (Lancet 1966;2:75)

Mortality = 10-20% per yr, 5% per yr from peritonitis in those with CAPD (Perit Dial Int 1997;17:S15)

Zinc deficiency (Am J Clin Pathol 1971;56:17) causes primary gonadal impairment, reversible with 2.5 mg po qd.

Amyloidosis (Kidney Int suppl 1993;41:S78)

Rare antacid Magnesium intoxication

Rare Cu intoxication from tubing (Nejm 1967;276:1209)

Iron deficiency

Increased ASHD (Lancet 1980;1:276)

Gynecomastia (Plast Reconstr Surg 1982;69:41)

Hepatitis C (Nephron 1993;65:40)

CaPO₄ deposits in joints (Contrib Nephrol 1984;84:58).

Catheter displacement in those with CAPD (Clin Nephrol 1999;52:124).

CVA (Stroke 1974;5:725)

Secondary hyperparathyroidism with change in bony structure (Kidney Int suppl 1993;41:S116).

Bleeding complications, secondary to platelet dysfunction and perhaps exacerbated by heparin use in those with hemodialysis (J Am Soc Nephrol 1991;2:961).

Infection at central catheter or shunt site in hemodialysis; tunnel infection and peritonitis in peritoneal dialysis (Arch Surg 1984;119:1325).

Scrotal swelling if patent processus vaginalis in those receiving peritoneal dialysis (Brit J Surg 1984;71:477)

Pure red cell aplasia with recombinant erythropoietin (Nejm 2002;346:469).