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

The primary causes of this patient’s acute kidney injury are:

1. Blood loss due to bleeding caused by a significant crush injury to her right upper extremity while on the job at a local construction site.

2. Organ failure (e.g., heart, liver) may occurs due to the crush injury but it is not provided in the patient's history.

3. AKI (Acute kidney injury) often occurs due to multiple processes such as nephrotoxic drugs or, especially following surgery or contrast agents or pinning and reconstructive surgery and received perioperative broad-spectrum antibiotics.

4. Decreased blood flow due to

Her kidney injury should be categorized as intrarenal because it is caused by a process within the kidneys which is sometimes caused by certain medication classes that can directly damage the tubular cells of the kidney and result in a form of intrinsic AKI..

She should be treated by dialysis to help replace kidney function until your kidneys recover.

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