Renal Case: 63-year-old Woman with Elevated Serum Creatinine

00:01 All right. Let's move onto a clinical case.

00:04 We have a 63 year old woman who is referred to you for the evaluation of an elevated serum creatinine of 1.6 milligrams per deciliter.

00:12 Her estimated GFR is 34 miles per minute by the ckd-epi equation.

00:17 And this was noted on at least three occasions.

00:20 She has no history of diabetes mellitus no history of chronic NSAID use and no history of stones or hypertension.

00:27 A renal ultrasound was obtained and it showed an increase in echogenicity, again meaning that that goes kidneys are brighter than the liver.

00:34 And slight thinnig of the renal cortices.

00:37 She discloses that she had an illness a year ago for which he was hospitalized at which time she was treated for septic shock in the ICU and noted nearly needing dialysis at that time.

00:48 So the question is what is the cause of her chronic kidney disease? Let's go through the case and see if we can answer that question.

00:57 So some important clues in the history.

00:59 She has no predisposing conditions or disease manifestations that would lead to CKD.

01:03 So that's a little bit a curious but look what is interesting on her Imaging exam.

01:09 She has an increase in echogenicity and thin cortices.

01:11 These are very suggestive that this patient has medical renal disease and our biggest clue is her history of that hospitalization.

01:20 She developed acute kidney injury because she told us she almost needed dialysis.

01:24 So most likely this patient has an unresolved tubular injury.

01:28 So again, if we think about what the most likely cause of her CKD is it is unresolved acute kidney injury.

01:35 And I think it's really important for us to take note of this.

01:39 That patients who develop acute kidney injury, whether they're hospitalized or outside of the hospital.

01:44 It's very likely that they develop chronic sequelae from that initial repeated episode of AKI and that can really manifest as chronic kidney disease and it's increasingly recognized as a cause of CKD.

01:55 So when you are talking to your patients, don't forget about really asking them about these hidden clues or hospitalizations that might help you arrive at the correct diagnosis.