Snapshot A 44-year-old woman with no significant past medical history presents to the emergency room with toxic ingestion of ethylene glycol. She answers appropriately but requires frequent redirection. Physical exam reveals bilateral flank pain. Her serum creatinine, previously normal, is now increased at 3 mg/dL. Urinalysis with sediment analysis reveals granular casts and significant hematuria. Fomepizole is given. Introduction Clinical definition login to view 1 more bullet Epidemiology login to view 8 more bullets Etiology login to view 13 more bullets Pathogenesis login to view 5 more bullets Prognosis login to view 20 more bullets Classification of Acute Renal FailuresUrinary IndicesPre-RenalIntrinsic RenalPost-RenalUrine osmolality (mOsm/kg)> 500< 350< 350Urine Na (mEq/L)< 20> 40> 40Serum BUN:creatinine> 20< 15< 15FENa (%)(fractional excretion of Na)< 1%> 2%> 2%FEUrea (%) (fractional excretion of urea)< 35%50-65 %- Presentation Symptoms login to view 8 more bullets Physical exam login to view 4 more bullets Imaging Ultrasound login to view 5 more bullets Studies Labs login to view 7 more bullets Urinalysis with microscopy and sediment analysis login to view 2 more bullets Diagnostic criteria login to view 8 more bullets Differential Prerenal azotemia login to view 1 more bullet Post-renal azotemia login to view 2 more bullets Treatment Conservative login to view 7 more bullets Medical login to view 6 more bullets Complications Electrolyte abnormalities login to view 2 more bullets Volume overload Uremia