The Clinical Problem Solvers Episode 21 – Intrarenal Acute Kidney Injury with Dr. Restrepo
8 snips
Mar 21, 2019 Dr. Daniel Restrepo, Chief Resident at Massachusetts General Hospital and an aficionado of medical education, shares valuable insights on intrarenal acute kidney injury (AKI). He discusses a compelling case study of a hiker with AKI, detailing her symptoms and the diagnostic approach. The conversation dives into differentiating AKI from chronic kidney issues, highlighting complex diagnostics and the significance of thorough history-taking. Restrepo also challenges conventional diagnostic norms, emphasizing critical thinking in clinical settings.
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Differentiating AKI from CKD
- Check prior creatinine levels or renal ultrasound to differentiate AKI from chronic kidney disease.
- Consider parathyroid hormone levels for chronic kidney disease indications like secondary hyperparathyroidism.
Prioritize Pre- and Post-Renal AKI
- Most AKI cases are due to hemodynamic (pre-renal) or obstructive (post-renal) causes.
- Prioritize assessing pre- and post-renal causes first using clinical clues and simple tests.
Manage Nephrotoxic Medications
- Always review and hold nephrotoxic medications when evaluating a patient with AKI.
- Adjust medication dosing as kidney function improves to prevent further injury.
