Why the creatinine was elevated!

To recap: At 4:30 am his repeat BMP returns 139 106 29 106 4.5 20 2.9 7.9   His creatinine kinase levels where 390 at 9 pm and 345 at 4:30 am When I saw him at 9 am, he had normal BP lying and standing, with a pulse around 90 at all times.  He had had a bladder scan that showed minimal urine, and his output was around 5 cc/hour. So the question for you is what do you do now?  You can order more tests.  You can order treatment.  You could get a consult.  You can criticize the new intern and resident. ====== My answer We had excluded obstruction, and in my mind the differential diagnosis was predominantly volume contraction versus acute tubular necrosis.  This differential is often complex, because volume contraction is a major risk factor for ATN.  Had the patient become hypotensive enough to damage his kidneys? I did criticize the intern and resident for not checking an FeNa at admission.  I admit a major bias in favor of this test – but ONLY IN OLIGURIC PATIENTS.  The original description in 1976 written by Dr. Carlos Espinel was published while he was my ward attending!  He explained it to us, and I have used it ever since.  A 1978 article – Urinary Diagnostic Indices in Acute Renal Failure: A Prospective Study – concludes: A prospective analysis of the value of urinary diagnostic indices in ascertaining the cause of acute renal failure was undertaken. Our results show that in the setting of acute oliguria a diagnosis of potentially...
Source: DB's Medical Rants - Category: Health Medicine and Bioethics Commentators Authors: Tags: Acid-Base & Lytes Attending Rounds Source Type: blogs