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1、AcuteKidneyInjury:currentconceptsregardingdiagnosisandmanagementDavidA.Makil,M.D.KantorNephrologyConsultantsLasVegas,NVAKICase#145y.o.malepresentstoERwithsubjectiveweightgain,fatigue,andvomiting.HehadapreviouslynormalPEx,serumchemistries3monthspriortocur
2、rentpresentation.CurrentlyhehasBP150/110,perorbitaledema.LabsincludeBUN85,SCr9.0;UAshows2+protein/blood,andcellularcastsWhatstatementisleastlikelytobecorrect?RenalbiopsyisindicatedPost-strepGNisintheDDxExtracapillarycellproliferationislikelySpontaneousre
3、solutionofthisparticularAKIislikelyHigh-dosesteroidsareindicatedAKICase#265y.o.malepresents7daysfollowingadiagnosticcoronaryangiogram;symptomsincludeabdpainandconfusion.PExrevealsdiminishedperipheralpulses,livedoreticularis,epigastrictenderness,andaltere
4、dmentalstatus.Labs:BUN131,SCr5.2;UAshows10-15WBC,5-10RBC,onehyalinecastperHPFThemostlikelydiagnosisis:AINsecondarytoNSAIDSpttakingpost-LHCRhabdomyolysiswithATNATNsecondarytoradiocontrastexposure,nephropathyCholesterolembolizationRenalarterialdissectionwi
5、thprerenalazotemiaAKICase#350y.omaleisreceivingampicillinandgentamicinforthepast2weeksfortreatmentofenterococcalendocarditis.Hehasremainedfebrile.Labs:Na145,K5.0,Cl110,HCO320BUN40,SCr3.5UA0-1WBC,UrineNa20,Cr35Whichofthefollowingisthemostlikelyprocessimpl
6、icatedinthispatient’sAKI?AcutetubularnecrosisInsensibleskinlossesRenalarteryembolismDecreasedcardiacoutput/CHFAcuteinterstitialnephritisAKICase#430y.ofemalewithESRDsecondarytoDMnephropathyreceivesacadavericrenalallograft.ByPOD#3,herSCris1.8mg/dLonaregime
7、noftacrolimus/prednisone/mycophenolate.OnPOD#5shedevelopsoliguria,andtheSCrincreasesto2.2mg/dL.HerBPis160/80andstable;temp37.2CThebestinitialstepinthispatient’smanagementwouldbeto:DecreasethedoseoftacrolimusObtainultrasonagraphyoftheallograftAdministerIV
8、LasixandmonitorurineoutputEmpiricpulsesteroidtherapyObtainbiopsyofallograftAcuteKidneyInjury2ndCenturyAD:Galensurmisesurineformedfromkidneys330-1453AD:ByzantinephysiciansdescribeoliguriaassymptomofAKI,aswellasdetailedurine
