Elevated Creatinine Flashcards
15yo girl with elevated creatinine: likely causes
- dehydration
- third-spacing and hypoperfusion == sepsis, SIRS
- acute tubular necrosis (TOXIC, damage to tubular cells) = Vanco, Gent, Contrast
- Acute interstitial nephritis (INFLAMMATORY/ALLERGIC, damage to interstitium) = NSAIDS, sulfa, Vanco, PCN/cephalosporins
15yo girl with elevated creatinine: lethal causes
- glomerular disease (auto-immune)
- Recurrent UTI ==> kidney scarring
- Pyelonephritis = (1) post-renal, obstructive; (2) dehydration, (3) sepsis and hypoperfusion
- Ischemic damage due to ATN
- congenital anomaly limiting functional tissue
- lack of mobility == baseline low Creatinine
Jillian is 15yo female with hx of myelominingocele and shunted hydrocephalus (s/p VP shunt, mitrofanoff) presenting with worsening HA over 2-3, identified as VP shunt malfunction. No reports of FND or mental status change from home. no abd pain, changes in urine, or CVA tenderness. Elevated creatinine. Has been treating HA with ibuprofen (400mg/day).
- consideration?
- physical exam
- hx of myelomeninocele == congenital cause of anatomic/functional urinary problems; risk of UTI
- chronic v. acute
- risk of infection
NSAIDs can cause damage
- AIN (interstitial/inflammation)
- (dose-dependent) vasoconstriction of afferent arteriole == decreased
==> esp if small child, dehydrated, RAS
PHYSICAL
- check MSK, signs of infection at mitrofanoff, skin exam, flank pain
complications of myelomeningocele
- neurogenic bladder, UTIs
- partial/complete paralysis of legs (esp. with location of myelomeningocele being lower)
- bowel problems = GI disorders
- hydrocephalus
- meningitis
- learning disabilities
- latex allergies / skin problems
AIN
- history
- pathophysiology
- presentation
- workup
HISTORY
- exposure to medications
PATHOPHYSIOGLOY
- inflammatory/allergic
PRESENTATION
- flank pain
- rashes (b/c inflammation)
- fever
- UA = eosinophils, white cells, WBC casts
US of kidneys = normal, or echogenic
PROGNOSIS
- decreased renal fx, permanent damage/scarring
- if stop meds == reversible
Causes of chronic interstitial nephritis
- SLE
- Sjogrens