physical function related to volume overload Other presenting symptoms of AKI may be nonspecific such as malaise and nausea In other instances, the initial complaint will be related to an underlying systemic or infectious cause for the AKI Triage considerations AKI includes a wide spectrum of disease and severity Initial triage should be based on overall clinical appearance and hemodynamic stability Patients with hypertensive crisis, respiratory distress from volume overload, or life-threatening dysrhythmias from electrolyte disturbances warrant emergent stabilization Children with more mild presentations may undergo further evaluation into underlying causes at the onset Clinical assessment A thorough history is necessary to reveal the underlying etiology of AKI A detailed history of fluid balance should be obtained The quality and quantity of urine should be identified Recent medications should be reviewed to identify potential causes of drug-induced nephrotoxicity Important classes of medications that increase the risk for AKI include nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensinconverting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), aminoglycoside antibiotics, and calcineurin inhibitors The patient should be evaluated for hypertension, and the physical examination should assess hydration status and perfusion as well as evaluate for edema and evidence of third spacing The patient’s weight should be compared to a “dry weight” or recent weight prior to the onset of illness, when possible The examination may reveal signs of systemic vasculitis associated with nephritis, such as rashes or arthritis The presence of a palpable bladder or mass, which may be compressing the urinary tract or stemming from the kidneys themselves, should be assessed for during the abdominal examination Laboratory assessment of AKI serves two purposes First, it should determine the severity of renal dysfunction and identify associated electrolyte, metabolic, or hematologic abnormalities, which may require urgent intervention Secondly, a focused investigation should be aimed at determining the underlying cause of AKI based on the clinical presentation of the patient Initial serum laboratory studies should include serum creatinine, electrolytes, and complete blood cell counts Children with AKI may demonstrate hyperkalemia, hypo- or hypernatremia, AG acidosis,