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renal.aki.post-renal.v1

Acute Kidney Injury — Post-renal (Obstructive) Mechanism

nephrologyacuteadultpediatricpregnancyacuteinpatient
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Promoted to INTEGRATED 2026-05-22 (shard-4 build campaign): added registry-resolving workups (aki, aki_on_ckd, nephrolithiasis, hematuria); every evidence.pmid re-sourced and live-verified via PubMed; every regimen RxCUI reverse-looked-up live at RxNav. Diagnostic pivot: hydronephrosis on US/CT + bladder distention OR catheter relief OR PCN/stent decompression with brisk Cr improvement (KDIGO 2012 AKI). 12 obstructive sub-phenotypes encoded as severity_triggers. PMID anchors (live-verified PubMed 2026-05-22): 22890468 KDIGO 2012 AKI, 32668114 STARRT-AKI, 27181456 AKIKI, 27238616 AUA Stones, 34384237 AUA LUTS/BPH 2021. Prior placeholder PMIDs were fabricated/mis-attributed and have been removed. RxCUI corrections (reverse-verified at RxNav): piperacillin/tazobactam 74169, meropenem 29561, gentamicin 1596450, tamsulosin 77492, finasteride 25025, prednisone 8640, tamoxifen 10324 (prior 203563/2191/17244/38400/36567/8638/7052 resolved to wrong drugs). Sibling routing: renal.aki.v1, uro.urolithiasis.v1, uro.bph.v1, renal.aki.prerenal.v1, renal.aki.intrinsic.atn.v1. Obstruction-specific workup IDs remain schema-blocked in clinical-tools-registry (cross-shard ticket).

Entry points (6)

  • lab_abnormality
    Cr rise with anuria / oliguria / fluctuating output (KDIGO 2012 AKI)
    creatinine_rise_anuria
  • symptom
    Suprapubic fullness / distention + acute urinary retention (AUA BPH 2021 PMID 34384237)
    suprapubic_distention
  • symptom
    Flank pain ± renal colic ± hematuria — obstructive uropathy (AUA Stone 2016 PMID 27238616)
    flank_pain_obstruction
  • imaging
    Hydronephrosis on bedside US / CT (KDIGO 2012 AKI)
    hydronephrosis_us
  • history
    Pelvic / retroperitoneal malignancy with new oliguria (KDIGO 2012 AKI)
    pelvic_malignancy
  • history
    Spinal cord injury / neurogenic bladder with high PVR (KDIGO 2012 AKI)
    spinal_cord_injury_neurogenic_bladder

Required inputs (12)

  • agerequired
    demographic • used at CONTEXT
    Age + sex drive BPH vs gyn-malignancy probability (AUA BPH 2021)
  • creatininerequired
    lab • used at CONTEXT
    KDIGO staging + Cr response to decompression (KDIGO 2012 AKI)
  • baseline_creatininerequired
    lab • used at CONTEXT
    Required to compute Cr ratio for KDIGO stage (KDIGO 2012 AKI)
  • potassiumrequired
    lab • used at INITIAL_WORKUP
    Hyperkalemia from oliguria + obstructive AKI; AEIOU criterion (KDIGO 2012 AKI)
  • urinalysisrequired
    lab • used at INITIAL_WORKUP
    Hematuria → stone; pyuria → infected obstruction → STAT decompression (AUA Stone 2016)
  • urine_outputrequired
    vital • used at CONTEXT
    Anuria / oliguria / fluctuating output suggests obstruction (KDIGO 2012 AKI)
  • sbprequired
    vital • used at CONTEXT
    Hemodynamic screen — obstructed-infected kidney → urosepsis (AUA Stone 2016)
  • renal_bladder_usrequired
    imaging • used at INITIAL_WORKUP
    First-line — hydronephrosis + bladder distention (KDIGO 2012 AKI)
  • bladder_scan_pvrrequired
    imaging • used at INITIAL_WORKUP
    Post-void residual >300 mL supports outlet obstruction (AUA BPH 2021)
  • bph_history
    history • used at CONTEXT
    BPH history + recent anticholinergic / decongestant exposure (AUA BPH 2021)
  • pelvic_malignancy_history
    history • used at CONTEXT
    Cervical / prostate / colorectal / bladder cancer with progressive ureteral compression (KDIGO 2012 AKI)
  • recent_pelvic_surgery_or_radiation
    history • used at CONTEXT
    Iatrogenic ureteral injury / radiation-induced fibrosis (KDIGO 2012 AKI)

12-phase flow (12)

  1. 1FRAME
    Confirm AKI by KDIGO 2012 staging AND obstruction profile on imaging (hydronephrosis / bladder distention / new anuria) (KDIGO 2012 AKI)
    inputs: creatinine, baseline_creatinine
    advance: KDIGO criteria met + post-renal pivot suspected
  2. 2ENTRY
    Anuria / oliguria / fluctuating output + flank pain / suprapubic distention / hematuria (KDIGO 2012 AKI; AUA Stone 2016)
    inputs: urine_output
    advance: Obstructive entry features documented
  3. 3CONTEXT
    BPH / pelvic malignancy / radiation / spinal injury / pregnancy / pediatric urologic history (AUA BPH 2021; KDIGO 2012 AKI)
    inputs: age, sbp, bph_history, pelvic_malignancy_history, recent_pelvic_surgery_or_radiation
    advance: Obstructive context catalogued
  4. 4RED_FLAGS
    Infected obstruction (urosepsis with hydronephrosis) → STAT decompression; bilateral obstruction or single-kidney obstruction; hyperkalemia + anuria; pregnancy with obstruction (KDIGO 2012 AKI; AUA Stone 2016)
    inputs: potassium, sbp
    advance: Time-critical decompression decision made
  5. 5INITIAL_WORKUP
    Renal/bladder US, bladder scan PVR, BMP, UA, CBC, blood culture if febrile, foley placement (KDIGO 2012 AKI; AUA BPH 2021)
    inputs: urinalysis, renal_bladder_us, bladder_scan_pvr
    actions: panel.renal, panel.cbc, panel.inflammation
    advance: Obstruction level localized (upper vs lower; uni vs bilateral)
  6. 6BRANCHING_WORKUP
    Non-contrast CT KUB for stone, CT urography or MRU for tumor / RPF, retrograde ureteropyelography if ambiguous, cystoscopy for clot/fungus ball (AUA Stone 2016; KDIGO 2012 AKI)
    advance: Etiology of obstruction confirmed
  7. 7DIFFERENTIAL
    Sub-phenotypes: bilateral ureteral obstruction / single-kidney obstruction / BPH-AUR / pelvic malignancy compression / RPF / urolithiasis / neurogenic bladder / iatrogenic injury / clot / fungus ball / pediatric PUJ / pregnancy / post-obstructive diuresis (KDIGO 2012 AKI; AUA Stone 2016)
    advance: Sub-phenotype documented
  8. 8RISK_STRATIFICATION
    KDIGO stage 1/2/3; infected vs non-infected; recoverability vs CKD legacy (KDIGO 2012 AKI; STARRT-AKI NEJM 2020)
    inputs: creatinine
    actions: calc.ckd_epi_2021
    advance: Stage + sub-phenotype severity documented
  9. 9TREATMENT
    STAT decompression appropriate to level (foley for outlet, PCN or retrograde stent for ureteral); treat underlying (stone removal, TURP, oncologic stent, RPF steroids); deprescribe anticholinergics; monitor post-obstructive diuresis with hypotonic replacement (50-75% UOP) (AUA Stone 2016; AUA BPH 2021; KDIGO 2012 AKI)
    inputs: urine_output
    advance: Decompression executed + underlying plan set
  10. 10DISPOSITION
    ICU if infected obstruction + sepsis OR severe electrolyte derangement; admit if needs IR/uro intervention; outpatient if uncomplicated stone with successful retrograde stent (KDIGO 2012 AKI; AUA Stone 2016)
    advance: Disposition + consults complete
  11. 11MONITORING
    Strict I/O hourly post-decompression (post-obstructive diuresis); BMP q6-12h; Cr trajectory; replace 50-75% UOP with 0.45% NaCl during PO-diuresis; AVOID 100% replacement (perpetuates diuresis) (KDIGO 2012 AKI)
    inputs: urine_output, creatinine
    actions: panel.renal
    advance: PO-diuresis phase resolved + Cr trajectory documented
  12. 12FOLLOWUP
    Urology / nephrology / oncology follow-up by phenotype; permanent monitoring of solitary kidney + bilateral obstruction risk; stone metabolic workup; BPH med-rec; review anticholinergic burden (AUA Stone 2016; AUA BPH 2021; KDIGO 2024 CKD)
    advance: Specialty follow-up + patient education complete