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Renal Case: 72-year-old Woman with Altered Mental Status

by Amy Sussman, MD

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    00:01 Let's move on to a case to illustrate what we're talking about.

    00:04 You're asked to see a 72-year-old woman who is admitted to the hospital from a skilled nursing facility.

    00:10 She has altered mental status and her caregiver notes that she hasn't been eating or drinking very much for the past several days.

    00:17 Her physical exam is remarkable for orthostatic hypotension.

    00:21 She has tenting of her skin and dry mucous membranes.

    00:25 Her laboratory evaluation is remarkable for a serum creatinine of 2.3 mg/dL, so clearly we can see that's elevated.

    00:33 Her BUN is also high at 58 mg/dL.

    00:38 So our patient is given 2 liters of normal saline and her serum creatinine decreases to 1.3 mg/dL the following morning.

    00:47 So the question is, what type of acute kidney injury does this woman have? Let's go through our case and see if we can find an answer.

    00:56 So there's a couple of clinical clues that really help us.

    00:59 Number 1, if we look in her history, it states that she really hasn't been eating or drinking for the past several days so we're already thinking in our mind, she may very likely be hypovolemic.

    01:11 On physical exam, we actually have signs of hypovolemia.

    01:14 Our patient has orthostatic hypotension.

    01:17 She has tenting of her skin with dry mucous membranes.

    01:21 And then our labs are very important because we have a creatinine of 2.3 (mg/dL) indicating that our patient has acute kidney injury.

    01:28 And we also see that if we give our patient volume to re-expand her vascular space and restore her volume status, Lo and behold, her creatinine goes down to 1.3 (mg/dL), that means that she's got a reversible injury or that she's pre-renal.

    01:45 So our answer is that this patient has pre-renal AKI due to volume depletion.


    About the Lecture

    The lecture Renal Case: 72-year-old Woman with Altered Mental Status by Amy Sussman, MD is from the course Acute Kidney Injury (AKI).


    Included Quiz Questions

    1. Patient C presents to the emergency department after a motor vehicle collision. Surgery is performed for splenic laceration, with an estimated blood loss of 1,500 mL. On postoperative day 1, the patient has newly elevated creatinine and BUN levels.
    2. Patient A presents to the clinic for a routine evaluation with a complaint of fatigue. There is a history of spinal cord injury causing urinary retention, and creatinine and BUN levels are chronically elevated.
    3. Patient B presents to the endocrine clinic for a diabetes check-up. A recent HbA1c value was 10.4%, and the patient is noncompliant with insulin use. Creatinine and BUN levels are chronically elevated.
    4. Patient D presents to the clinic for a routine evaluation. The patient is training for a 10 km run and has been using 2,000 mg ibuprofen daily for 4 weeks to help with soreness. Creatinine and BUN levels are chronically elevated.

    Author of lecture Renal Case: 72-year-old Woman with Altered Mental Status

     Amy Sussman, MD

    Amy Sussman, MD


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