Renal Case: 63-year-old Woman with Elevated Serum Creatinine

by Amy Sussman, MD

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    00:01 All right. Let's move onto a clinical case.

    00:04 We have a 63 year old woman who is referred to you for the evaluation of an elevated serum creatinine of 1.6 milligrams per deciliter.

    00:12 Her estimated GFR is 34 miles per minute by the ckd-epi equation.

    00:17 And this was noted on at least three occasions.

    00:20 She has no history of diabetes mellitus no history of chronic NSAID use and no history of stones or hypertension.

    00:27 A renal ultrasound was obtained and it showed an increase in echogenicity, again meaning that that goes kidneys are brighter than the liver.

    00:34 And slight thinnig of the renal cortices.

    00:37 She discloses that she had an illness a year ago for which he was hospitalized at which time she was treated for septic shock in the ICU and noted nearly needing dialysis at that time.

    00:48 So the question is what is the cause of her chronic kidney disease? Let's go through the case and see if we can answer that question.

    00:57 So some important clues in the history.

    00:59 She has no predisposing conditions or disease manifestations that would lead to CKD.

    01:03 So that's a little bit a curious but look what is interesting on her Imaging exam.

    01:09 She has an increase in echogenicity and thin cortices.

    01:11 These are very suggestive that this patient has medical renal disease and our biggest clue is her history of that hospitalization.

    01:20 She developed acute kidney injury because she told us she almost needed dialysis.

    01:24 So most likely this patient has an unresolved tubular injury.

    01:28 So again, if we think about what the most likely cause of her CKD is it is unresolved acute kidney injury.

    01:35 And I think it's really important for us to take note of this.

    01:39 That patients who develop acute kidney injury, whether they're hospitalized or outside of the hospital.

    01:44 It's very likely that they develop chronic sequelae from that initial repeated episode of AKI and that can really manifest as chronic kidney disease and it's increasingly recognized as a cause of CKD.

    01:55 So when you are talking to your patients, don't forget about really asking them about these hidden clues or hospitalizations that might help you arrive at the correct diagnosis.

    About the Lecture

    The lecture Renal Case: 63-year-old Woman with Elevated Serum Creatinine by Amy Sussman, MD is from the course Chronic Kidney Disease (CKD).

    Included Quiz Questions

    1. Unresolved AKI may lead to CKD.
    2. Pre-existing CKD decreases the risk of AKI.
    3. AKI and CKD are two separate, mutually exclusive entities.
    4. AKI can slow the progression of pre-existing CKD.

    Author of lecture Renal Case: 63-year-old Woman with Elevated Serum Creatinine

     Amy Sussman, MD

    Amy Sussman, MD

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