Young man with prolonged post-ictal state found to have marked renal failure due to ATN
Dr. Jai Radhakrishnan | Morning Report | 06/21/2016
AKI = abrupt loss of renal function as detected by measurement of serum Cr and GFR, results in the retention of urea and other nitrogenous waste products
Posted 06/21/16 11:31:12 AM by Anna Krigel
AKI work up:
- should focus on pre-renal, intrinsic renal, and post-renal causes - to assess for pre-renal, assess volume status on exam; if not clinically obvious, bolus 1-2L IV fluid - to assess for obstruction, order a renal ultrasound immediately; can even do bedside sono of bladder - to assess intrinsic renal causes of AKI, order a UA
Posted 06/21/16 11:32:57 AM by Anna Krigel
In thinking about AKI, can divide the kidney into its compartments
1) Glomerulus - nephrotic or nephritic syndrome, see protein and/or RBCs on UA 2) Vessels - vasculitides, thrombosis 3) Tubules - ATN (50% of all cases of AKI) 4) Interstitium - AIN, see WBCs on UA and can see systemic signs of fever, skin rash
Posted 06/21/16 11:36:56 AM by Anna Krigel
ATN pearls and management
- ischemic ATN = oliguric - toxic ATN = distal tubules affected, usually not oliguric, most often from aminoglycosides - management of ATN is supportive with fluids and RRT if needed
Posted 06/21/16 11:39:55 AM by Anna Krigel
Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.