Abbreviated medical protocols from EdREN, the website of the Renal Unit of the Royal Infirmary of Edinburgh
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 |
Neil Turner, David Kluth and John Neary were the main authors for this page. It was updated in November 2006, last amended
NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.