Rapidly Progressive Renal Failure Diagnostic Workup

Authored by Sourabh Sharma, published on 2026-11-12 16:11:05.0

  1. Identify RPRF: Progressive Kidney Impairment Over Days to Weeks
    • Identify Oliguria, Hyperkalaemia, Acidosis, Pulmonary Oedema, Uraemia, or Shock
      • Immediate Stabilisation or Nephrology Assessment Needed?
        • Stabilise and Obtain Immediate Nephrology Assessment
          • Urgent Kidney Replacement Therapy Indicated?
            • Start Urgent Kidney Replacement Therapy With Nephrology
              • Confirm Creatinine Trajectory, Baseline CKD, Urine Output, and AKI Chronicity
                • Perform Urinalysis, Microscopy, ACR/PCR, and Determine Proteinuria Pattern
                  • Obstruction Causing Kidney Failure?
                    • Urgently Decompress Clinically Significant Obstruction
                    • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                      • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Haemodynamic Response or Infiltrative Features Present?
                        • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Review Drugs, Contrast, Toxins, Infections, and Systemic Disease Features
                  • Obstruction Causing Kidney Failure?
                    • Urgently Decompress Clinically Significant Obstruction
                    • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                      • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Haemodynamic Response or Infiltrative Features Present?
                        • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Assess Volume, Perfusion, Sepsis, and Cardiac Function
                  • Obstruction Causing Kidney Failure?
                    • Urgently Decompress Clinically Significant Obstruction
                    • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                      • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Haemodynamic Response or Infiltrative Features Present?
                        • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Obtain Renal Ultrasound and Assess Bladder Emptying
                  • Obstruction Causing Kidney Failure?
                    • Urgently Decompress Clinically Significant Obstruction
                    • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                      • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Haemodynamic Response or Infiltrative Features Present?
                        • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Screen With SPEP/UPEP, Serum/Urine Immunofixation, and Serum Free Light Chains
                  • Obstruction Causing Kidney Failure?
                    • Urgently Decompress Clinically Significant Obstruction
                    • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                      • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Haemodynamic Response or Infiltrative Features Present?
                        • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Obtain CBC, Blood Film, LDH, Haptoglobin, CK, Calcium, and Targeted Infection Tests
                  • Obstruction Causing Kidney Failure?
                    • Urgently Decompress Clinically Significant Obstruction
                    • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                      • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Haemodynamic Response or Infiltrative Features Present?
                        • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                          • Is Aetiology Established With Adequate Confidence?
                            • Follow Confirmed Cause-Specific Management Pathway
                            • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
            • Confirm Creatinine Trajectory, Baseline CKD, Urine Output, and AKI Chronicity
              • Perform Urinalysis, Microscopy, ACR/PCR, and Determine Proteinuria Pattern
                • Obstruction Causing Kidney Failure?
                  • Urgently Decompress Clinically Significant Obstruction
                  • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                    • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Haemodynamic Response or Infiltrative Features Present?
                      • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
              • Review Drugs, Contrast, Toxins, Infections, and Systemic Disease Features
                • Obstruction Causing Kidney Failure?
                  • Urgently Decompress Clinically Significant Obstruction
                  • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                    • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Haemodynamic Response or Infiltrative Features Present?
                      • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
              • Assess Volume, Perfusion, Sepsis, and Cardiac Function
                • Obstruction Causing Kidney Failure?
                  • Urgently Decompress Clinically Significant Obstruction
                  • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                    • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Haemodynamic Response or Infiltrative Features Present?
                      • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
              • Obtain Renal Ultrasound and Assess Bladder Emptying
                • Obstruction Causing Kidney Failure?
                  • Urgently Decompress Clinically Significant Obstruction
                  • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                    • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Haemodynamic Response or Infiltrative Features Present?
                      • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
              • Screen With SPEP/UPEP, Serum/Urine Immunofixation, and Serum Free Light Chains
                • Obstruction Causing Kidney Failure?
                  • Urgently Decompress Clinically Significant Obstruction
                  • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                    • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Haemodynamic Response or Infiltrative Features Present?
                      • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
              • Obtain CBC, Blood Film, LDH, Haptoglobin, CK, Calcium, and Targeted Infection Tests
                • Obstruction Causing Kidney Failure?
                  • Urgently Decompress Clinically Significant Obstruction
                  • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                    • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                    • Haemodynamic Response or Infiltrative Features Present?
                      • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                        • Is Aetiology Established With Adequate Confidence?
                          • Follow Confirmed Cause-Specific Management Pathway
                          • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                      • Is Aetiology Established With Adequate Confidence?
                        • Follow Confirmed Cause-Specific Management Pathway
                        • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
        • Confirm Creatinine Trajectory, Baseline CKD, Urine Output, and AKI Chronicity
          • Perform Urinalysis, Microscopy, ACR/PCR, and Determine Proteinuria Pattern
            • Obstruction Causing Kidney Failure?
              • Urgently Decompress Clinically Significant Obstruction
              • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Haemodynamic Response or Infiltrative Features Present?
                  • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
          • Review Drugs, Contrast, Toxins, Infections, and Systemic Disease Features
            • Obstruction Causing Kidney Failure?
              • Urgently Decompress Clinically Significant Obstruction
              • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Haemodynamic Response or Infiltrative Features Present?
                  • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
          • Assess Volume, Perfusion, Sepsis, and Cardiac Function
            • Obstruction Causing Kidney Failure?
              • Urgently Decompress Clinically Significant Obstruction
              • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Haemodynamic Response or Infiltrative Features Present?
                  • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
          • Obtain Renal Ultrasound and Assess Bladder Emptying
            • Obstruction Causing Kidney Failure?
              • Urgently Decompress Clinically Significant Obstruction
              • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Haemodynamic Response or Infiltrative Features Present?
                  • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
          • Screen With SPEP/UPEP, Serum/Urine Immunofixation, and Serum Free Light Chains
            • Obstruction Causing Kidney Failure?
              • Urgently Decompress Clinically Significant Obstruction
              • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Haemodynamic Response or Infiltrative Features Present?
                  • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
          • Obtain CBC, Blood Film, LDH, Haptoglobin, CK, Calcium, and Targeted Infection Tests
            • Obstruction Causing Kidney Failure?
              • Urgently Decompress Clinically Significant Obstruction
              • Which Diagnostic Phenotype(s) Are Present? Evaluate Overlaps in Parallel
                • Suspected RPGN: Test ANCA, Anti-GBM, ANA, Anti-DSDNA, Complement, and Arrange Urgent Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Stop Suspected Drug; Evaluate AIN and Biopsy if Diagnosis Remains Unclear
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate ATI/ATN, Rhabdomyolysis, Haemolysis, and Pigment Nephropathy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate Myeloma, Cast Nephropathy, MGRS, and Amyloidosis; Expedite Kidney Biopsy
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Evaluate TMA, Renal Artery or Vein Thrombosis, and Systemic Vasculitis
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                • Haemodynamic Response or Infiltrative Features Present?
                  • Treat Volume Depletion, Shock, or Cardiorenal Syndrome; Reassess
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Evaluate Lymphoma, Leukaemia, Amyloidosis, and Other Infiltrative Disease
                    • Is Aetiology Established With Adequate Confidence?
                      • Follow Confirmed Cause-Specific Management Pathway
                      • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
                  • Is Aetiology Established With Adequate Confidence?
                    • Follow Confirmed Cause-Specific Management Pathway
                    • Expedite Kidney Biopsy if Safe; Use Higher-Yield Alternative Tissue
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