Challenge: For each of the following, would you expect these findings in prerenal acute kidney injury or acute tubular necrosis (ATN)?
1. Mannitol administration.
2. ACE-inhibitors.
3. Severe burns.
4. A history of vomiting and diarrhea.
5. Muddy brown casts.
6. Bland urinalysis with rare hyaline casts.
7. Improvement of creatinine within 48 hours after IV fluid administration.
8. FENa < 1%
9. BUN/Cr = 12:1.
10. Urine Na+ = 50meq/L.
skip to main |
skip to sidebar
I put together these medical challenges. The cases are hypothetical and do not necessarily represent actual or typical presentations of medical diseases. Disclaimer is at the bottom of this page.
Blog Archive
Labels
- Announcements (48)
- Emergency Medicine (217)
- Family Medicine (261)
- Internal Medicine (407)
- Neurology and Psychiatry (199)
- Obstetrics and Gynecology (126)
- Other (22)
- Pediatrics (208)
- Surgery (195)
- USMLE "Classic Findings" (25)
Posts
Disclaimer
The content of this site is for educational purposes only. The author of the site does not provide any medical advice and information here should not be construed or used as such. Using this site does not create a physician-patient relationship and is not intended to replace the services of a licensed, trained physician or health professional. No health or medical related decision should be based in whole or in part on anything contained here. Any opinions expressed here are not necessarily those of the author nor do they reflect the opinions of any of the author's affiliations. Content on this site may be changed without notice and is not guaranteed to be complete, correct, or up-to-date. Any comments posted to the site can be edited, modified, or removed by the author of this site.
2 comments:
1. You mean history of mannitol administration? Pre-Renal Failure- (cause excessive mannitol can cause dehydration which can lead to pre-renal failure)
2. Pre-Renal Failure
3. Pre-Renal Failure
4. Pre-Renal Failure
5. ATN
6. Pre-Renal Failure
7. Pre-Renal Failure
8. Pre-Renal Failure
9. Pre-Renal Failure
10. ATN
i really hope i'm right.. most of them are just guesses :(
Renal II
Causes of prerenal disease include volume depletion (GI , renal, respiratory, or skin loss including burns, third spacing), hypotension, low effective circulating volume states (cirrhosis, heart failure, nephrotic syndrome), renal ischemia (bilateral stenosis, hepatorenal syndrome), and impairment of autoregulation (NSAIDs, ACEi). The U/A is normal or near normal (hyaline or fine granular casts are okay). FENa is <1%. BUN/Cr > 20:1. Urine sodium is <20meq/L, urine osm >500mOsm, and oliguria.
Causes of ATN include ischemia, nephrotoxins (aminoglycosides, amphotericin, cisplatin, contrast, mannitol). U/A shows muddy brown granular and epithelial casts and free renal tubular epithelial cells. FENa is >2%. BUN/Cr = 10-15:1. Plasma Cr rise is progressive at a rate >0.3mg/dL/day. Urine sodium is >40meq/L, urine osm <450 mOsm.
Thus, 1 is both prerenal and ATN. Prerenal is 2, 3, 4, 6, 7, 8. ATN is 5, 9, 10.
Source: UpToDate.
Post a Comment