A high degree of suspicion is often needed to identify patients with or at risk for AKI. It is important to identify risk factors for AKI, such as hypovolemic status, pre-existing kidney or cardiac disease, recent infection, or exposure to nephrotoxic medications. A review of systems should include questions about gastrointestinal symptoms, the presence of swelling, estimated fluid intake and urine output, as well as urinary symptoms such as dysuria and change in urine appearance. The past medical history should address whether the patient has any previous cardiac, urologic, or oncologic diagnoses that may place them at higher risk. When inquiring about medications, the emergency clinician should ask about prescribed and over-the-counter agents. Assessing family history for kidney disease, nephrolithiasis, or autoimmune disease may not identify children at risk but can assist in narrowing an otherwise broad differential if pAKI is present.
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