Monday, January 19, 2009


You're doing a medicine rotation when you get consulted by trauma surgery. The patient is a diabetic with known heart failure who got into a motor vehicle accident one day ago. Several serial CT scans yesterday afternoon ruled out any surgical emergency and he was admitted for observation. He was not hypotensive or in shock. This morning, his creatinine reaches 4mg/dL. You call his primary medical doctor and find that his baseline creatinine is 2mg/dL. He has not gotten any new medications.

Challenge: What's the most likely diagnosis?


shabnam said...

Probably Contrast-medium induced nephrotoxicity...the serial CT's done in quick succesion,known history of diabetic renal impairment(increased baseline serum creat) and heart failure,both of which are predisposing factors,since they cause reduced renal clearance of the contrast medium...the serum creat would be expected to rise furthur nd peak in about 3-4 days.

wat say,craig? :)

Alex said...

problem with contrast agent?

Craig Chen said...

I can't get anything past you guys!

This is radiocontrast media-induced acute kidney injury which is usually reversible. Risk factors include underlying renal insufficiency (plasma Cr 1.5), diabetic nephropathy with renal insufficiency, heart failure, PCI, and high dose contrast. Renal failure occurs within 12-24 hours of the contrast study.

Source: UpToDate.