Acute Kidney Injury (AKI) History OSCE Checklist

1. Introduction

• Wash hands, introduce yourself, confirm patient identity
• Explain: “I’d like to ask some questions about your symptoms and kidney health.”
• Gain consent and ensure comfort
• Check if the patient is currently passing urine and if they feel acutely unwell

2. Presenting Complaint

• What brought you to hospital today?
• When did the problem start?
• Has it been getting worse, improving, or fluctuating?
• Has anyone told you your kidney function or creatinine is abnormal?

3. Urine History

• Have you noticed you are passing less urine than usual?
• When did you last pass urine?
• Are you passing no urine at all?
• What colour is your urine?
  • Dark/concentrated urine
  • Red, pink, or cola-coloured urine
  • Cloudy or foul-smelling urine
• Any frothy urine?
• Any pain or burning on passing urine?
• Urinary frequency, urgency, fever, or loin pain?
• Difficulty starting urine, weak stream, terminal dribbling, or incomplete emptying?
• Any urinary incontinence?
• Any lower abdominal fullness or suprapubic pain?

4. Volume Loss and Pre-renal Causes

• Have you had vomiting or diarrhoea? How frequent and for how long?
• Poor oral intake, thirst, inability to drink, or difficulty swallowing?
• Fever, sweats, or recent infection?
• Any bleeding:
  • Vomiting blood
  • Black stools or rectal bleeding
  • Heavy menstrual bleeding
  • Recent operation or trauma
• Have you felt dizzy, faint, or had palpitations when standing?
• Any recent burns?
• Recent excessive sweating, heat exposure, or strenuous exercise?

5. Sepsis and Systemic Illness

• Fever, rigors, or feeling generally unwell?
• Cough, breathlessness, sputum?
• Abdominal pain or diarrhoea?
• Painful urination or flank pain?
• Skin infection, wounds, ulcers, or recent surgery?
• Confusion or drowsiness?

6. Intrinsic Renal Disease Clues

• Blood in urine or cola-coloured urine?
• New swelling of legs, face, or around the eyes?
• Headache or symptoms of high blood pressure?
• Frothy urine?

• Rash or purpura?
• Joint pains?
• Mouth ulcers, photosensitivity, Raynaud symptoms?
• Sinus pain/nasal crusting or nosebleeds?
• Coughing blood or new breathlessness?

• New rash, fever, or joint pains after starting a medicine?

• Severe muscle pain, weakness, crush injury, prolonged immobility, seizures, intense exercise, or dark brown urine?

7. Obstruction and Post-renal Causes

• Previous kidney stones or renal colic?
• Loin-to-groin pain?
• History of enlarged prostate, prostate cancer, pelvic malignancy, or retroperitoneal disease?
• Previous urinary tract surgery, catheterisation, or urethral stricture?
• Neurological disease affecting bladder emptying, such as spinal injury, multiple sclerosis, or diabetes?

8. Drug History

• NSAIDs: ibuprofen, naproxen, diclofenac
• ACE inhibitors or ARBs: ramipril, lisinopril, losartan
• Diuretics: furosemide, bendroflumethiazide
• Antibiotics, especially aminoglycosides
• Proton-pump inhibitors
• Lithium
• Chemotherapy or immunotherapy
• Recent iodinated contrast scan or angiography
• Herbal remedies or bodybuilding supplements
• Recreational drugs, including cocaine or IV drug use

9. Past Medical History

• Previous AKI or kidney disease?
• Baseline renal function or known eGFR/creatinine?
• Diabetes, hypertension, heart failure, liver disease?
• Vascular disease?
• Recurrent UTIs, kidney stones, or prostate disease?
• Autoimmune disease such as lupus or vasculitis?
• Malignancy?
• Recent hospital admission, operation, ICU admission, or contrast exposure?

10. Social History

• Usual fluid intake and recent intake
• Alcohol intake
• Smoking
• Recreational drug use
• Recent travel, diarrhoeal illness, or infectious contacts
• Occupation and toxin exposure
• Functional status: can they independently access fluids and medications?

11. Systems Review

• Breathlessness, orthopnoea, leg swelling, chest pain
• Nausea, vomiting, anorexia, pruritus
• Confusion, drowsiness, headache
• Weight change
• Rash or bruising

Red Flags to Escalate Immediately

• Anuria or rapidly worsening oliguria
• Sepsis or hypotension
• Hyperkalaemia symptoms: palpitations, weakness, syncope
• Pulmonary oedema: acute breathlessness, orthopnoea
• Uraemic features: confusion, pericarditic chest pain, persistent vomiting
• Suspected infected urinary obstruction: fever plus loin pain/retention
• Haematuria with proteinuria suggesting nephritis

Closing Summary

“To summarise, this patient has had reduced urine output for ___ days, associated with ___, with possible causes including pre-renal fluid loss / sepsis / nephrotoxic medication / urinary obstruction. I would assess observations, volume status, fluid balance and urine output, review medications, check urinalysis and blood tests including U&Es, and consider renal ultrasound if obstruction is suspected.”

1. Pre-renal: hypovolaemia, sepsis, heart failure
2. Intrinsic renal: ATN, nephritis, interstitial nephritis, rhabdomyolysis
3. Post-renal: obstruction