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All of these tests should be considered in patients with acute renal failure. Be selective, but keep an open mind even if the diagnosis appears to be clear. The list applies also to patients with a lesser degree of renal impairment who have an acute or immunological renal illness. The blue spot indicates ­ do it in everyone.

 

Test Essential? Comments
FBC + plats, film, diff film essential in ARF
(ESR)   misleading; do CRP instead
CRP  
Clotting screen additional tests if abnormal
Group & save  
Biochemistry  
Calcium + phosphate even a high-normal Ca is abnormal
Myoglobin , CK   if rhabdomyolysis possible
     
Blood cultures do in almost all with ARF of whatever cause
Other cultures   wound, sputum, catheters etc
Hepatitis and HIV serology   Urgent HepB +HIV may need dialysis; but also for other disease
CMV, VZV   If to be immunosuppressed; consider EBV and HIV also
ASOT/ throat swab/ other   if post-strep GN possible
Other serology   leptospires, syphilis, hantavirus, etc., (rarely)
MSU  
Bence Jones protein   patients >35y with poorly explained ARF
Urinary prot 24h or spot protein/creatinine ratio
CXR  
Renal Ultrasound  USUALLY URGENTLY REQUIRED
ECG  If > 40 or any risk factors for cardiac disease
Pulmonary function   in systemic disease, acutely and after recovery
Immunoglobulins, prot elect   in most patients
Complement   in almost all
ANF, etc   and DNA antibodies if ANF positive
ENA   if suspect interstitial nephritis or atypical SLE
Rheumatoid factor    
ANCA   all possibly inflammatory disease
Anti-GBM   all possible RPGN
Cryoglobulins   if C4 low or otherwise indicated

 

Acknowledgements:   Neil Turner, David Kluth and John Neary were the main authors for this page. The last modified date is shown in the footer.

 

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This page last modified 04.03.2013 12:59 by Emma Farrell. edren and edrep are produced by the Renal Unit at the Royal Infirmary of Edinburgh and the University of Edinburgh. CAUTIONS and Contact us.