Question

There are three general categories of AKI, acute kidney injury. There is pre-reneal and reneal ( intrinsic) and post-renal.

for this case, Jacob is 78 year old who got admitted to the ED for heart stroke and he also has dehyrdration after he fall down in his garage. after getting addmitted to inside the ED he started to have a seziure and respiratory function became compromised. The patient got transferred to ICU.

his diagonsis is respiratory faliure, aspiration pneumonia, respiratory faliure, s/p intubation, seziure, rhabdomyolysis, AKI, hyperthermia-resolved

his medical history is that he has diverticulosis, type 2 DM, GERD, and COPD

his medications: fentanyl which is sedative, versed (sedative), dilantin ( anticonvulsant), dilantin (anticonvulsant)

the question: based on this information, what is the main cause for Jacob AKI? ( consider the three general categories of AKI)

Answer 1

The categories of Acute Kidney Injury are prerenal, intrinsic renal and post renal .

In pre renal AKI, the basic kidney function may be normal, but the decreased kidney perfusion caused by other systemic functions like cardiac or decreased intravascular volume etc will cause the AKI.

The intrinsic renal AKI is due to the disruption in any component of the kidney system like tubular, vascular, glomerular or interstitial defects.

The post renal AKI causes are intra renal or extrarenal obstructions like prostatic hypertrophy,tumors, cancers, stones in the renal system etc.

Here in case of Jacob, 78 year old who got admitted to the ED shows heart stroke and he also has dehyrdration after he fall down in his garage, the major cause of AKI is pre renal. The history of this client doesn't show direct kidney diseases and the AKI is the result of heart stroke and dehydration.

The heart stroke and reduced intra vascular volume (caused by dehydration) led to a decreased perfusion status of the systems, causing decreased renal perfusion and reducing the glomerular filtration rate.

Since the client has Type 2 DM, there can be an intrinsic renal cause too, as this condition can damage the renal components mostly the vascular destruction. The client is 78 yrs old, so might be a diabetic for long and the diabetic nephropathy might had occured too.

So the reason for AKI in case of Mr Jacob is mostly Pre renal and partially Intrinsic renal.