Tropical Acute Kidney Injury: Etiologic Evaluation

Authored by Sourabh Sharma, published on 2026-11-12 16:37:50.0

Adult With Suspected Tropical AKI
- Confirm and Stage AKI by KDIGO; Establish Baseline and Urine Output
  - Shock or Life-Threatening AKI Complication?
    - Stabilize and Obtain Urgent Nephrology or Critical Care Support
      - Assess Haemodynamics, Volume Status, and Nephrotoxin Exposure
        
        Obtain CBC, Smear, Chemistry, LFTs, CK, Urine Studies, Cultures, and Renal Ultrasound
        
        Map Local Epidemiology, Travel, Season, Exposures, Medications, and Organ Involvement
        
        Which Etiologic Phenotypes Are Present?
        
        Which Infectious Syndromes or Exposure Clues Are Present?
        
        Test Malaria With Thick/Thin Smears, RDT, and Parasite Density
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Test Dengue by Illness Day With NAAT/NS1 or Serology
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Test Leptospirosis With Phase-Appropriate PCR and Serology
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Inspect for Eschar; Test Scrub Typhus and Rickettsioses
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Obtain Blood, Urine, and Stool Cultures; Evaluate Sepsis-Associated ATI
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Test Hantavirus and Other Endemic Pathogens With Public Health Support
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate Heat Stress, Dehydration, Diarrhoeal Losses, and Rhabdomyolysis
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate Envenomation With Coagulation, Hemolysis, CK, and Urine Testing
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Identify Nephrotoxic Drugs, Herbal Remedies, Chemicals, and Contaminated Water Exposures
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Which Urinary or Hematologic Pattern Is Present?
        
        Evaluate Glomerulonephritis With Urine Microscopy, Protein Quantification, Complement, and Serologies
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate TMA, DIC, and Hemolysis; Escalate Urgently
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate AIN From Drugs and Infections; Seek Nephrology Input
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Obtain Blood, Urine, and Stool Cultures; Evaluate Sepsis-Associated ATI
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Arrange Urgent Urinary Decompression and Urologic Handoff
    - Assess Haemodynamics, Volume Status, and Nephrotoxin Exposure
      - Obtain CBC, Smear, Chemistry, LFTs, CK, Urine Studies, Cultures, and Renal Ultrasound
        
        Map Local Epidemiology, Travel, Season, Exposures, Medications, and Organ Involvement
        
        Which Etiologic Phenotypes Are Present?
        
        Which Infectious Syndromes or Exposure Clues Are Present?
        
        Test Malaria With Thick/Thin Smears, RDT, and Parasite Density
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Test Dengue by Illness Day With NAAT/NS1 or Serology
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Test Leptospirosis With Phase-Appropriate PCR and Serology
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Inspect for Eschar; Test Scrub Typhus and Rickettsioses
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Obtain Blood, Urine, and Stool Cultures; Evaluate Sepsis-Associated ATI
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Test Hantavirus and Other Endemic Pathogens With Public Health Support
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate Heat Stress, Dehydration, Diarrhoeal Losses, and Rhabdomyolysis
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate Envenomation With Coagulation, Hemolysis, CK, and Urine Testing
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Identify Nephrotoxic Drugs, Herbal Remedies, Chemicals, and Contaminated Water Exposures
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Which Urinary or Hematologic Pattern Is Present?
        
        Evaluate Glomerulonephritis With Urine Microscopy, Protein Quantification, Complement, and Serologies
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate TMA, DIC, and Hemolysis; Escalate Urgently
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Evaluate AIN From Drugs and Infections; Seek Nephrology Input
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Obtain Blood, Urine, and Stool Cultures; Evaluate Sepsis-Associated ATI
        
        Differentiate Infection-Specific AKI, Sepsis-Associated ATI, GN, TMA, and Coincident Causes
        
        Etiology or Coexisting Etiologies Established and Course Explained?
        
        Assign Etiology and Follow Cause-Specific Management Pathway
        
        Repeat Phase-Dependent Tests; Biopsy Non-Recovering AKI, Active Sediment, Suspected GN or AIN
        
        Arrange Urgent Urinary Decompression and Urologic Handoff

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