Renal Pathophysiology

11

Acute Kidney Injury

CASE PRESENTATION-1 A 56-year-old woman has a history of hypertension and inflammatory bowel disease. Her blood pressure is 130/74 mm Hg on lisinopril-hydrochlorothiazide combination therapy. She suffered an ankle sprain playing tennis for 2 weeks and has been taking ibuprofen 600 mg twice a day since then. Her inflammatory bowel disease has been well controlled, but over the last 2 to 3 days, she noted crampy abdominal and frequent loose stools. She presents to her primary care physician and is noted to have a blood pressure of 122/70 mm Hg. There was no edema, and the remainder of the examination was normal. Baseline creatinine from a routine physical was 0.8 mg/dL 3 months previously.

The following blood and urine studies are noted: Blood urea nitrogen (BUN) = 32 mg/dL (9-25) Creatinine = 3.2 mg/dL (0.8-1.4) Urine Na = 42 mEq/L Urine osmolality = 300 mOsm/kg FENa = 2.5% Urinalysis

= negative blood, protein; sediment with no cells or casts

OBJECTIVES

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By the end of this chapter, you should have an understanding of each of the following issues:  The estimation of the glomerular filtration rate (GFR) is the primary test used to estimate the degree of renal function

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