A healthy 26-year-old woman sustained a significant crush injury to her right up

Question

A healthy 26-year-old woman sustained a significant crush injury to her right upper extremity while on the job at a local construction site. She was brought to the emergency department and subsequently underwent pinning and reconstructive surgery and received perioperative broad-spectrum antibiotics. Her blood pressure remained normal throughout her hospital course. On the second hospital day, a medical consultant noted a marked increase in her creatinine, from 0.8 to 1.9 mg/dL. Her urine output dropped to 20 mL/h. Serum creatine kinase was ordered and reported as 3400 units/L.

Questions

What are the primary causes of this patient’s acute kidney injury? How should her kidney injury be categorized (as prerenal, intrarenal, or postrenal)?

How should she be treated?

Explanation / Answer

Primary cause is due to crush injury to her right upper extremity.
The patient has intrarenal failure because her creatinine levels are increased and there is a drop in the urine output.
Treatment is dialysis and fluid restriction.

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