Renal Case: 56-year-old Man with Coronary Angiography

00:01 Let's now transition to the intrinsic renal portion.

00:04 So diseases that actually affect the tubules and interstitium are what we're gonna focus on.

00:09 And that includes acute tubular necrosis, acute interstitial nephritis and acute tubular obstruction.

00:18 So you're asked to see a 56-year-old gentleman who recently underwent coronary angiography with stent placement to his left anterior descending artery for acute coronary syndrome.

00:28 His serum creatinine was noted to increase 2 days following the procedure.

00:33 His physical exam is relatively unremarkable and his serological labs show that his serum creatinine is elevated to 2.3 mg/dL, so we see that that's high.

00:44 And his creatinine was 0.9 (mg/dL) which is normal on the day of the angiography, His BUN is only slightly elevated at 28 mg/dl.

00:53 He's given 2 liters of normal saline but his creatinine continues to rise.

00:57 So the question is, what type of acute kidney injury does this gentleman have? Let's go through our case and see if we can answer that question.

01:05 In the history, I think it's very important to note that temporal correlation between the administration of contrast and the creatinine rising essentially 48 hours after contrast administration.

01:17 We can also see on the laboratory data that that BUN to creatinine ratio is actually less than 15:1.

01:25 And when we see that, taken together with the history, that's very suggestive of a tubular injury.

01:31 The fact that he doesn't get better with volume replacement trying to correct his renal hemodynamics, really does suggest that there's intrinsic renal disease going on here.

01:40 So the answer to our case, is that this gentleman does have intrinsic renal disease and in fact, has acute tubular necrosis from his radiocontrast administration.