Rare and Overlooked Causes of Acute Kidney Injury

  • José A. MorfínEmail author
  • Shruti Gupta


Entities like acute tubular injury and prerenal acute kidney injury (AKI) remain well-recognized causes of AKI; however, the spectrum of AKI is wide and encompasses often-overlooked causes of kidney injury. In this section, we describe seven causes of AKI that should be considered when evaluating a patient with new-onset AKI. These include cholemic nephropathy, anticoagulation-related nephropathy, oxalate nephropathy, drug-related crystalluria, abdominal compartment syndrome, cholesterol embolization, and drug-induced AKI. As with other causes of AKI, evaluation for these etiologies involves a thorough history and physical, along with attention to urinalysis and urine microscopy. In the setting of drug-induced AKI (particularly acyclovir nephrotoxicity) and oxalate nephropathy, characteristic crystals may be seen on urine sediment. While renal biopsy is often the “gold standard” in making the diagnosis, it is often contraindicated, as in anticoagulation-related nephropathy and cholemic nephropathy, where the risk of bleeding is high. In most of these conditions, it is critical to maintain a high index of suspicion; abdominal compartment syndrome, for instance, is potentially life-threatening if it goes untreated. These “rare” causes of AKI may be more common than previously thought; with the increasing prevalence of drugs of abuse, including opioids and synthetic cannabinoids, nephrologists will almost certainly encounter AKI directly attributable to drug use.


Acute kidney injury Drugs of abuse Abdominal compartment syndrome Drug-induced crystalluria Atheroembolic disease Hyperoxaluria Bile acid nephropathy 


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Nephrology, Department of Internal MedicineUniversity of California Davis School of MedicineSacramentoUSA
  2. 2.Division of Renal Medicine, Department of MedicineBrigham and Women’s HospitalBostonUSA

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