AKI Consultation Note (Nephrology)

Date/Time: [Date and time of consult]

Patient Location: [Unit/bed]

Requesting Service/Clinician: [Service and clinician name]

Consult Type: [initial / follow-up]

Consulting Nephrologist: [Name, credentials]

(Omit content when information is missing rather than inserting placeholders, except for above header fields and Reason for Consult. Do not auto-import entire medication lists or lab panels—include only clinically relevant items. Populate Summary and Recommendations even if other sections are sparse.)

Reason for Consult

[Primary consult question and secondary questions if requested] (If reason not specified, document what can be inferred from chart context.)

Summary and Recommendations

(Actionable items for the primary team. Populate this section even when other sections are sparse.)

• AKI Stage and Trajectory: [KDIGO stage by creatinine and/or urine output criteria] — [improving / stable / worsening]; [oliguric / non-oliguric]
• Etiology (most likely): [One-sentence etiology with key supporting evidence] (If uncertain, state uncertainty and what data would reduce it.)
• Immediate Actions:
  • Hemodynamics/Volume: [Volume expansion / diuresis / maintain euvolemia] with goals [targets]
  • Nephrotoxin Mitigation: [Agents to hold and alternatives]
  • Diagnostics Now: [Labs, urine studies, imaging to obtain]
  • Electrolyte/Acid-Base Interventions: [Specific treatments if needed]
• RRT Stance: [No indication at this time / Urgent indication present] (If not initiating, list concrete escalation triggers.)

Clinical Context

[One-sentence summary: age, kidney history, major comorbidities, reason for hospitalization, current kidney status]

Baseline Kidney Function and AKI Timeline

(Required section. Use observed data when available. Do not silently infer baseline—label any estimate with method and limitations. Note eGFR unreliability during non–steady state if reporting.)

• Baseline serum creatinine: [Value, date] — [outpatient labs / prior admission / HIE / unknown]
• Baseline CKD stage: [Stage / unknown]
• Trajectory:
  • Admission creatinine: [Value, date/time]
  • Peak creatinine: [Value, date/time]
  • Most recent creatinine: [Value, date/time]; Rate of change: [Delta per 24h]
• Urine output trend: [Value and trend over 6–24h] — [oliguric / non-oliguric]; Measurement reliability: [Foley / strict I/Os / unreliable]
• KDIGO stage: [Stage by creatinine and/or urine output criteria]

Hospital Course (AKI-Focused)

(Chronological narrative beginning when kidney function changed. Include concurrent events, fluid management and response, vasopressor requirements, nephrotoxic exposures with timing, and relevant obstructive/uremic/systemic symptoms. Omit history unrelated to AKI.)

[Chronological narrative]

Pertinent History

(Omit items that do not apply.)

• [Prior AKI episodes with dates/context]
• [Proteinuria, hematuria, or glomerular disease]
• [Nephrolithiasis or obstruction history]
• [Structural abnormalities, solitary kidney, nephrectomy, transplant]
• [Comorbidities affecting AKI: heart failure, cirrhosis, diabetes, myeloma, vascular disease]

Medication and Nephrotoxin Review

• Current nephrotoxic/renally-dosed medications: [Agent, dose, start date] (ACEi/ARB, NSAIDs, diuretics, aminoglycosides, vancomycin, amphotericin, antivirals, chemotherapy)
• Recent exposures:
  • Iodinated contrast: [Date, volume/type if known]
  • Rhabdomyolysis risks: [Statins, crush injury, seizures, heat, substances]
  • Other nephrotoxins: [Agent and timing]
• Drug levels: [Vancomycin/tacrolimus levels if relevant]
• Home medications: [Only if etiologically relevant]

(If medication history is incomplete, document reason.)

Physical Exam

(If exam limited, specify limitation and what was assessed.)

• Vitals/Hemodynamics: [HR, BP, MAP with trend, temperature, O2 needs] — [Perfusion interpretation]
• Volume status: [JVP, mucous membranes, lung exam, peripheral edema, ascites]
• Cardiopulmonary: [Heart and lung findings]
• Abdomen/Bladder: [Distension, suprapubic fullness, tenderness]
• Skin: [Rash, livedo, blue toes]
• Neuro: [Asterixis, encephalopathy]
• Vascular access: [Dialysis catheter, fistula, graft if present]

Objective Data

(Curate relevant data with timestamps. Omit subsections without pertinent findings.)

• Intake/Output and Weights: [Last 24h I/O, cumulative balance, weight trend]
• Renal panel trends: [Cr, BUN, K, bicarb, Na, Ca, Phos, Mg with key timestamps]
• Acid-base: [ABG/VBG, lactate, anion gap]
• CBC: [Eosinophilia, hemolysis markers if relevant]
• Urinalysis and sediment: [Dipstick; microscopy findings including casts] (Note who reviewed sediment.)
• Urine chemistries: [Urine Na, Cr, FeNa/FeUrea] (Note confounders: diuretics, CKD.)
• Imaging: [Renal ultrasound, bladder scan, CT findings]

Assessment

AKI Statement: Acute Kidney Injury, KDIGO stage [stage], [oliguric / non-oliguric], [improving / stable / worsening]

Baseline: [Observed / Estimated] creatinine [value] from [date, source] (If estimated, state method and limitations.)

Trajectory: [Rate and direction of creatinine change; urine output trend]

Etiology Assessment: [Assessment using pre-renal, intrinsic, and post-renal framework with supporting and refuting evidence] (Avoid overconfident exclusions when uncertainty remains.)

Complications: [Hyperkalemia, acidosis, volume overload, uremic symptoms, drug accumulation risk]

Plan

1. Acute Kidney Injury
   • Diagnostics: [Labs guided by differential; urine microscopy timing; imaging if obstruction indicated; biopsy consideration]
   • Hemodynamics/Volume: [Strategy] with goals [MAP, UOP, perfusion targets]
   • Nephrotoxin Mitigation: [Agents to hold and alternatives]
   • Renal Dosing: [Medication adjustments]
   • Monitoring: [BMP schedule, strict I/Os, daily weights, trigger-based K checks]
   • Escalation Triggers: [Concrete thresholds for calling nephrology/ICU or initiating RRT]
2. Electrolytes/Acid-Base (Include when abnormal)
   • Hyperkalemia: [Medical therapy and escalation criteria]
   • Acidosis: [Bicarbonate strategy or RRT triggers]
   • Other electrolytes: [Management as needed]
3. Volume Overload (Include if present)
   • Respiratory status: [Work of breathing, oxygenation]
   • Diuretic strategy: [Agent, dose, route, response assessment]
   • RRT criteria: [Thresholds if refractory]
4. Obstruction Evaluation (Include when clinically plausible)
   • Risk assessment: [Symptoms, risk factors]
   • Foley/bladder scan: [Findings]
   • Imaging: [Ultrasound/CT if indicated]
   • Urology triggers: [When to involve]

   (If obstruction unlikely, state brief rationale and omit further detail.)

5. Renal Replacement Therapy Contingency (Required for stage 2–3, oliguria, or complications)
   • Current indication: [None / Present — specify indication]
   • Contingency triggers: [Refractory hyperkalemia, refractory pulmonary edema, severe acidemia, uremic complications, toxin indications]
   • Modality: [IHD vs CRRT considerations; anticoagulation]
   • Access plan: [Line type/site if RRT anticipated]
   • Goals of care: [Decision-maker status and alignment]

Follow-Up

[Anticipated recovery course; lab schedule; inpatient reassessment timing; outpatient nephrology plan if relevant]

Communication

[Recipients updated, key shared decisions, verbal communication of critical recommendations]