AKI

Situation:

21 y.o. female, PMHx biliary colic s/p cholecystectomy. Presented with new-onset severe bilateral flank pain. Imaging showed bilateral kidney inflammation. Now with worsening AKI, hematuria, proteinuria, and coag-negative staph UTI.

Background:

• PMHx: biliary colic s/p cholecystectomy

• Initial workup: CT with bilateral renal inflammation

• UTI: urine culture positive for coag-negative staph

• Current Cr: 2.5 (plateaued)

• Protein-to-creatinine ratio: elevated at 0.23

• Labs: LDL, C3, C4 negative

• US renal veins/arteries: no occlusion

• Nephrology consulted

Assessment:

• AKI – etiology unclear. Differential includes pyelonephritis vs AIN/ATI.

• Possible pyelonephritis – on empiric ceftriaxone (Rocephin).

• Pain – severe bilateral flank pain, managed with scheduled and PRN Dilaudid.

Recommendation/Plan:

• Appreciate renal recs

• f/u PR3, MPO, ANA, Anticardiolipin Abs

• d/c IV fluids

• Avoid NSAIDs and nephrotoxins

• Trend BMP daily

• Continue Rocephin 1g IV q24h

• Continue Dilaudid 4mg PO q4h scheduled + 4mg PRN q4h

• Continue Tylenol 1000mg q6h

• Regular diet

• Full Code