• Listen

    Has there been change in urination? Urine color? Frequency? How much fluid is the patient taking in? Are associated symptoms present? Nausea? Headache? Malaise? Lung edema? Are there symptoms indicative of: Urinary tract infection? Pyelonephritis? Worsening CHF? Are symptoms limiting ADLs? Current or recent use of nephrotoxic medications (prescribed and OTC), other agents? NSAIDs Antibiotics

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  • Look

    Does the patient appear uncomfortable? Does the patient look ill?

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  • Recognize

    Laboratory abnormalities (elevated creatinine, electrolyte abnormalities) Urinalysis abnormalities (casts) Abdominal or pelvic disease that could be causing symptoms Prior history of renal compromise? Other immune-related adverse effects? Presence of current or prior immune-mediated toxicities, including rhabdomyolysis Is patient volume depleted?

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