Visual summary
Address the cardiac, hepatic, infectious, or medication driver and evaluate intrinsic injury when the course does not fit a purely functional explanation.
Text version
Effective arterial filling
Kidney perfusion depends on more than total body water. Heart failure and cirrhosis can reduce effective arterial filling while substantial edema is present.
Recognize mixed physiology
Hypotension, venous congestion, vasodilation, infection, and drug effects can coexist. A swollen patient may still have impaired renal perfusion.
Assess both compartments
Use history, examination, weight and fluid trends, urine findings, and focused imaging when useful. No single laboratory ratio defines the hemodynamic problem.
Choose the direction of therapy
Fluid replacement, decongestion, or vasoactive support address different mechanisms. Reassess the response rather than repeating an intervention simply because creatinine is abnormal.
Interpret creatinine during treatment
A rise during decongestion requires assessment of perfusion and residual congestion. It is not automatically evidence that necessary fluid removal should stop.
Treat the whole syndrome
Address the cardiac, hepatic, infectious, or medication driver and evaluate intrinsic injury when the course does not fit a purely functional explanation.
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