Acute Kidney Injury case presentation

ByDr.Heba Allah Abouzaid

Under supervision Prof. Dr. Osama Al-Shahat

By The end of this presentation we will be able to :

• Define AKI and how to identify cases.

• Discuss how to make investigation (laboratory and Imaging ) for our case.

• Identify AKI Examination(General and Local examination )

• List management procedure for this case .

1. Personal history .

2. Investigation .

3. Examination.

4. Management .

• Afemal patient named , Manal yousefMahmoud , Aged 18 years old ,married has one sibling aged 20 days, born and lived in Kafr Al-sheikh ,house wife and have not any special habits of medical importance.

• Complaint:

Decrease urine output 5 days ago .

• History of present illness:

The condition started 17 days ago when the patient had caesarean section operation for delivery .

2 days later the patient developed oliguria of acute onset ,progressive course which developed after 2 days by complete anuriaup till now . The patient received trials of diuretics but without response ,so decision of haemodialysis was taken on . The base of laboratory data , no puffiness of face, edema of lower limbs ,fever ,lion pain ,dysuria .

Frequency gross haematuria ,nausea, vomiting, high cough or prurities . The condition was associated with diffuse abdominal pain of acute onset , regressive course with medications , no haematemesis ,halitosis ,dysphagia ,jaundice ,diarrhea , constipation , nor melena . No symptoms suggesting other system affection as there are no dyspnea, orthopnea , PND ,palpitation , cough or wheezes.

• Past history :

There is a history of C.S 17 days ago , No D.M. , HTN, TB , blood transfusion .

• Family history : No medical renal diseases .

a) Urine analysis : Not done as the patient is anuric.

b) CBC : • WBC :10 000• Hb : 7.5 gm / dl • MCV : 76• MCH : 23• platelets: 300 000 c) Liver function test : • normal apart from albumin = 2.8• Corrected Ca = 10.7• PO4 = 6.2

d) Kidney function test :

• Urea : 212 mg/dl .

• Creatinine : 10.5

• Na :138

• K: 4.1

• Uric acid : 9.4

• LDH= 1162

• Amylase: 460

Serology• ANA = -ve

• CRP= +ve 96

a) Chest X ray : free , no cardiomegally ,normal costophrenic angle , no lung shadows or masses.

b) U/s : Kidney :normal site ,size ,preserved C/O differentiation and normal echogenicity.

c) Brain C.T. : free

d) Abdominal C.T. : normal a part from bilateral acute renal cortical necrosis .

• The patient is conscious oriented as regards time , place and persons , over weight , no special decubitus.

• There is pallor ,no jaundice ,no cyanosis .• B.P = 120/80• Pulse : 80 beat/minute . Regular ,average volume equal on both

sides ,no special characters.• Head and neck : There is a central line insertion at the Rt .

Internal vein , normal scalp hair .• There are ulcers of the lips.• No malar flushes .• Hands: there is pallor , no clubbing , no cyanosis , no atrophic

changes , normal temperature , no flapping tremors. • LLs: intact peripheral pulsations , no edema ,trophic changes or

ischaemic manifestation . Normal tempreture .• No palpable lymph nodes .

a) Cardiac : normal S1+ S2 , no adventious sounds.

b) Chest : normal shape ,decrease air entry on right side with no adventious sounds , normal TVF

c) Abdomen : enlarged abdominal contour . Normal position of umbilicus , normal pubic hair . No hermia ,no visible veins , no ascitis . Stria alba all over the abdomen , scare of C.S which healed by 1ry intention , no palpable organs , normal renal angles .

Supportive treatment in the form of antibiotics ,anti hyperacidity measures and vitamins .

Diuretic infusion as challenge test where no response was obtained . Then haemodialysiswas done .

Acute kidenyinjury for D.D.

1. pre renal .

2. Renal.

3. Post renal .

Renal