Acute Kidney Injury (AKI) Differential Diagnoses

Updated: Dec 10, 2022
  • Author: Biruh T Workeneh, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Diagnostic Considerations

Although acute kidney injury (AKI) is a potentially reversible condition, it can occur in patients with chronic kidney diseae. Every effort should be made to identify reversibility, even if improvement in kidney function is marginal. The best way to identify reversibility is by tracking the rate of deterioration of kidney function. If the rate fo deterioration accelerates, the cause should be sought and treated.

Differentials to consider in AKI include the following:

  • Abdominal aneurysm
  • Alcohol toxicity
  • Alcoholic ketoacidosis
  • Chronic kidney disease
  • Dehydration
  • Diabetic ketoacidosis
  • Gastrointestinal (GI) bleeding
  • Heart failure
  • Metabolic acidosis
  • Obstructive uropathy
  • Protein overloading
  • Renal calculi
  • Sickle cell anemia
  • Steroid use
  • Urinary obstruction
  • Urinary tract infection

Urine output in differential diagnosis

Changes in urine output generally correlate poorly with changes in the glomerular filtration rate (GFR). Approximately 50-60% of all causes of AKI do not produce oliguria. However, the identification of anuria, oliguria, and nonoliguria may be useful in the differential diagnosis of AKI, as follows:

  • Anuria (< 100 mL/day) - Urinary tract obstruction, renal artery obstruction, rapidly progressive glomerulonephritis, bilateral diffuse renal cortical necrosis

  • Oliguria (100-400 mL/day) - Prerenal failure, hepatorenal syndrome, and severe AKI

  • Nonoliguria (> 400 mL/day) - Acute interstitial nephritis, acute glomerulonephritis, partial obstructive nephropathy, nephrotoxic and ischemic acute tubular necrosis, radiocontrast-induced AKI, and rhabdomyolysis

Differential Diagnoses