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  #1  
Old 12-07-2012
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Kidney Management of Acute Kidney Injury

A 57‐yr‐old man is admitted after a MVA (multiple fractures and abdominal trauma). His BP is 95/60 mmHg. A noncontrast CT scan of the abdomen is negative. He is volume‐resuscitated with 5 L of NS, and his BP increases to 135/85 mmHg. 24r hours after admission, he is noted to have marked abdominal distension, his UOP has decreased to 10 ml/h, and his Cr is 2.3. CVP is 18 mmHg and Ur Na is 12 mEq/L. Urine sediment contains a few fine granular casts. A renal ultrasound demonstrates a small retroperitoneal hematoma without hydronephrosis and marked ascites. His intravesical pressure is 27 mmHg. Which ONE of the following choices is the MOST appropriate next step in the management of his AKI ?

A. Abdominal decompression
B. Placement of bilateral ureteral stents
C. Fluid resuscitation
D. Watchful waiting
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A. Abdominal decompression

he has abdominal compartment syndrome.


But the real choice should be:

F. Fire whoever ordered a
noncontrast CT scan on a patient with a BP of 95/60 mmHg.
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C prereanl azotemia leading to ATN fluids and diuretics
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True ...Its A-Abdominal Decompression

Novobiocin...what did u mean by real choice F-fire??

its not ATN...as shown by granular casts and 5L of N.S fluid resusictaition given in the beginning that improved hi sB.P from 95 upto 135 so that rules out ATN...which if developed does not improve with Fluid resusictation...his hypotension after fluid resuscitation is now due to Abdominal compartment syndrome

If I am wrong...than Anyone else?

Last edited by Dr.Hunny; 12-08-2012 at 09:57 AM.
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Quote:
Originally Posted by Novobiocin View Post
A. Abdominal decompression

he has abdominal compartment syndrome.


But the real choice should be:

F. Fire whoever ordered a noncontrast CT scan on a patient with a BP of 95/60 mmHg.

The CT tech probably wasn't aware of the word( Ct abdomen and pelvis W contrast). lol
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Quote:
Originally Posted by Novobiocin View Post
A. Abdominal decompression

he has abdominal compartment syndrome.


But the real choice should be:

F. Fire whoever ordered a
noncontrast CT scan on a patient with a BP of 95/60 mmHg.

Can u explain about it
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Quote:
Originally Posted by hamzarayes View Post
Can u explain about it
He has abdominal compartment syndrome due to very high intra-abdominal pressure leading to decreased renal perfusion.
They should not have sent him for a CT scan with a BP of 95/60 mmHg which means that he is hemodynamically unstable.
Moreover, a contrast CT scan is more useful in detecting intra-abdominal injuries but I can still understand them doing a noncontrast CT scan as they did not want to risk an ATN from contrast but nowadays there are contrasts available which are not nephrotoxic.
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Old 12-09-2012
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Does contrast agents always cause ATN in a pre-existing renal insufficiency OR it can cause ATN in a normally-functioning kidney as well?

Any one anwer plz...
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Excellent Novo
The correct ans is A. Abdominal decompression
abdominal compartment syndrome cause decrease of of renal perfusion from increased renal vein pressure from either intra-abdominal bleeding, pancreatitis, or abdominal surgery. Diagnosed by IBP> 20. And treated with surgical decompression of the abdomen
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Quote:
Originally Posted by Dr.Hunny View Post
Does contrast agents always cause ATN in a pre-existing renal insufficiency OR it can cause ATN in a normally-functioning kidney as well?

Any one anwer plz...
As i know contrast induced nephropathy ass with per-exiting renal abnormalities
Risk factors are:
1- Cre > 1.5 mg/dl
2- GFR < 60 ml/min/1.73 m2
3- DM
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The correct ans is A. Abdominal decompression
abdominal compartment syndrome cause decrease of of renal perfusion from increased renal vein pressure from either intra-abdominal bleeding, pancreatitis, or abdominal surgery. Diagnosed by IBP> 20. And treated with surgical decompression of the abdomen[/QUOTE]


IBP> 20 ??
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Quote:
Originally Posted by aknz View Post
IBP> 20 ??
The diagnosis of abdominal compartment syndrome (ACS) depends on accurate intra-abdominal pressure (IAP) measurement, which is usually performed via the bladder (intrabladder pressure IBP) or the stomach.
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Quote:
Originally Posted by Dr.Hunny View Post
Does contrast agents always cause ATN in a pre-existing renal insufficiency OR it can cause ATN in a normally-functioning kidney as well?

Any one anwer plz...
It can cause ATN in a normally-functioning kidney associated with low perfusion states (Hypovolemia) or high load states (paraproteins, ethylene glycol, post chemotherapy--high DNA load etc)
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