What is the role of peripheral smear in the workup of acute kidney injury (AKI)?

Updated: Dec 24, 2020
  • Author: Biruh T Workeneh, MD, PhD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The peripheral smear may show schistocytes in conditions such as hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP). A finding of increased rouleaux formation suggests multiple myeloma, and the workup should be directed toward immunoelectrophoresis of serum and urine.

The presence of the following, along with related findings, may help to further define the etiology of AKI:

  • Myoglobin or free hemoglobin - Eg, pigment nephropathy

  • Increased serum uric acid level - Eg, tumor lysis syndrome

  • Serum lactate dehydrogenase (LDH) - Eg, renal infarction


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