Acute Kidney Injury

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents for ‍newknown acute kidney injury



Lab results:

Creatininee ‍ ‍normal, BUN ‍ ‍normal, GFR ‍ ‍normal

Electrolytes ‍ ‍normal

Complete blood count ‍ ‍normal

Liver function tests ‍ ‍normal

Urinalysis ‍ ‍normal



Associated symptoms: *Try using right-click for negatives*

‍fatigue

‍shortness of breath

‍leg swelling, ‍rightleftsymmetrical

‍confusion

‍nausea

‍dehydration

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍obstructive urinary symptoms



Contributing factors:

no history of: ‍chronic kidney disease, ‍heart disease, ‍liver disease, ‍diabetes, ‍hypertension, ‍cancer

no use of: ‍contrast dye, ‍NSAIDs, ‍ACE inhibitors, ‍ARBs, ‍diuretics, ‍chemotherapy, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍Acute kidney injury ‍likelysuspectedpossible

DDx: prerenal kidney injury, intrinsic renal injury, postrenal obstruction, dehydration, hypovolemia, sepsis, shock, diuretic use, ACE inhibitor use, angiotensin receptor blocker use, NSAID-induced nephrotoxicity, contrast-induced nephropathy, drug-induced nephrotoxicity, acute tubular necrosis, glomerulonephritis, interstitial nephritis, urinary tract obstruction, renal ischemia, renal vein thrombosis, rhabdomyolysis, hemolytic uremic syndrome, multiple myeloma, systemic lupus erythematosus, scleroderma renal crisis, hepatorenal syndrome, acute pyelonephritis, complicated urinary tract infection





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍BUN

- Urine: ‍urinalysis, ‍urine culture, ‍urine electrolytes

- Renal ultrasound

- CT scan of abdomen

Treatments:

- Normal saline ‍ cc bolus, then ‍ cc/hr

- Stop medications: NSAIDs, diuretic, ACE, ARB, metformin

- Dietary modifications: ‍low sodium diet, ‍low potassium diet, ‍low protein diet

- Avoid NSAIDs

- Avoid contrast agents

Further care:

- Referral to nephrologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as swelling, shortness of breath, or decreased urine output