Case Presentation On Acute Kidney Injury: Lardel Kent D. Caray-Medical Clerk

CASE PRESENTATION ON
ACUTE KIDNEY INJURY

LARDEL KENT D. CARAY- MEDICAL CLERK
General data
R. L., 38 y.o.
Male, married
lineman
Talon-talon, Z.C
Chief complaint:
Loss of bowel movement
4 days PTA
•• Nausea
Nausea and
and
colicky
colicky
abdominal
abdominal painpain
•• Watery,
Watery, non-
non-
bloody,non
bloody,non
mucoid
mucoid stoolstool (2-3
(2-3 3 days
cups)
cups)
•• Took
Took loperamide,
loperamide, PTA
temporary
temporary relief
•• Patient’s
relief •• Persistence
Persistence Hours
Patient’s last
last of
of
meal
meal was
was atat a
a symptoms
symptoms PTA
karenderia
karenderia •• Onset
Onset of
of •• Vomiting
Vomiting xx
undocume
undocume 2
2 episodes
episodes
nted
nted fever
fever (1-2
(1-2 cups)
cups)
•• headache
headache •• Body
Body
malaise
malaise
•• Decrease
Decrease
urine
urine
output
output
Past medical history
No previous
hospitalization,
allergies, diagnosed
diseases, blood
transfusion
Family history
Hypertension on both
maternal ad paternal side
Personal / social
No vices
No illicit drug
Usual diet : fish, rice and
vegetables
Source of water: tap water
Review of systems
Body malaise
Loss of appetite
diarrhea
oliguria
Physical exam
T: 37.9 C
PR: 120 bpm Pallor, Sunken eyes
RR: 22 cmp
BP: 90/60 mmHg
O2Sat: 96% at room
air
Tachycardic
Normoactive bowel
sounds, non tender
abdomen
Sunken eyes, dry oral
mucosa
Clinical Diagnosis
PRIMARY DIAGNOSIS: Acute Kidney Injury

prob sec to Acute Infectious diarrhea with
moderate dehydration
SECONDARY DIAGNOSIS: AGE prob sec to

Amoebiasis
BASIS FOR IMPRESSION
AKI prob sec to Acute infectious diarrhea w/ AGE prob sec to Amoebiasis
moderate dehydration
History and PE findings of the patient History and PE findings of the patient which
which include: include:
• Diarrhea of less than 2 weeks
• Accompanied by fever, • Diarrhea
vomiting and abdominal pain • Lower abdominal pain
• Watery, non-bloody, non-
mucoid stools • Body malaise
• Weak-looking • Fever
• Tachycardic • Vomiting in some cases
• Hypotensive
• With signs of dehydration
(sunken eyes and dry oral
mucosa)
• We consider AKI, because the
patient accordingly noted a
decreased in his urine output
of half a cup of only 2 episodes
for the past 12 hrs
CASE DISCUSSION
PRIMARY DIAGNOSIS: Acute Kidney Injury prob
sec to Acute Infectious diarrhea with moderate
dehydration

A. ACUTE KIDNEY INJURY

• by definition, is the impairment of kidney filtration and
excretory function over days to weeks, resulting in the
retention of nitrogenous and other waste products
normally cleared by the kidneys.
• According to the KDIGO 2012 definition of AKI, it was
defined as any of the following:
 An increase in Serum creatinine concentration by >
0.3 mg/dL within 48h
 Increase in SCr concentration of at least 50% higher than
baseline w/in 1 week
 A decreased in urine output to less than 0.5 ml/kg per hour
for longer than 6 hours
CASE DISCUSSION
dehydration

• Prerenal AKI is the most common form of AKI. It

is the designation for a rise in SCr or BUN
concentration due to inadequate renal plasma
flow and intraglomerular hydrostatic pressure to
support normal glomerular filtration. The most
common clinical conditions associated with
prerenal azotemia are hypovolemia, decreased
cardiac output, and medications that interfere
with renal autoregulatory responses such as
nonsteroidal anti-inflammatory drugs (NSAIDs).
CASE DISCUSSION
dehydration

• Intrinsic AKI is commonly caused by sepsis,

ischemia, and nephrotoxins, both endogenous
and exogenous.
• PostRenal AKI occurs when the normally

unidirectional flow of urine is acutely blocked
either partially or totally, leading to increased
retrograde hydrostatic pressure and
interference with glomerular filtration.
Obstruction to urinary flow may be caused by
functional or structural derangements anywhere
from the renal pelvis to the tip of the urethra.
CASE DISCUSSION
dehydration

CASE DISCUSSION
dehydration

B. ACUTE INFECTIOUS DIARRHEA

• Acute diarrhea is the passage of three or
more loose, watery or bloody stools from an
immunocompetent person’s normal baseline in
a 24-hour period, with a duration of less than 14
days.
• Acute infectious diarrhea is acute diarrhea
that is usually accompanied by symptoms such
as nausea, vomiting, abdominal pain and fever,
and is caused by infectious agents such as
bacteria, viruses, fungi or protozoa.
CASE DISCUSSION
dehydration

Parameters Mild dehydration Moderate Severe dehydration
dehydration
Fatigue +/- + +
Thirst +/- + +
Sunken eyes - + +
Blood pressure Normal Orthostatic Shock

hypotension
Respiratory rate Normal 21 - 25 ≥25

(breaths per
minute)
Pulse rate (beats ≥80 ≥100 Faint or thready

per minute)a pulses
Peripheral Warm extremities Cold, clammy skin

circulation
Level of Alert Lethargic Coma or stupor

consciousness
CASE DISCUSSION
SECONDARY DIAGNOSIS: AGE prob sec to
Amoebiasis

2. Amoebiasis
• an infection caused by Entamoeba histolytica. It is often acquired by
ingestion of viable cysts from fecally contaminated water, food or hands;
however, food-borne infection is most prevalent. When in the small
intestine, motile trophozoites are released form the cysts and often live
as harmless commensals in the large intestines.
• In some patients, however, trophozoites may either invade Symptomatic

intestinal amoebiasis often begins with a gradual onset of lower
abdominal pain and mild diarrhea, followed by body malaise, weight loss
and diffuse lower abdominal or back pain. Severe diseases may cause
passage of up to 10 to 12 stools per day, with stools containing mostly
blood and mucus.
CASE DISCUSSION
II. PARACLINICAL DIAGNOSTIC
PROCEDURE

Certainty Treatment modality
1. AKI sec to Acute Infectious 80% Treat underlying cause

diarrhea
2. Amoebiasis 50% Treat underlying cause
Benefit Risk Cost Availability

1. Serum To assess possible lung infiltrates, No risk 90 available
creatinine or consolidation
2. CBC For assessment of possible No risk 175 available
increase in WBC specifically in
Neutrophils pointing towards
infection
3. Stool exam To assess for possible increased in No risk 30 available

microorganisms pointing towards
infection
4. Serum Na, K Assess possible electrolyte No risk 200 available

imbalance due to fluid loss
CASE DISCUSSION
II. PARACLINICAL DIAGNOSTIC PROCEDURE

For this case, both the serum creatinine and stool exam are
vital in diagnosing AKI and acute infectious diarrhea. For this
patient, the listed paraclinicals were done. There was an
increase in the serum creatinine of more than 0.3 mg/Dl. Stool
exam revealed a brown,soft stool with moderate bacterial
count.
CASE DISCUSSION
III. TREATMENT

 For the antibiotic regimen:

Azithromycin 1g single dose OR
Ciprofloxacin 500 mg twice daily for 3-5 days
 Fluid resuscitation is also needed to address the dehydration of the

patient
Moderate dehydration
For moderate dehydration, 500 to 1,000 ml of plain Lactated Ringer’s
solution (PLRS) in the first 2 hours is recommended. Once the patient is
hemodynamically stable, 2 - 3 ml/kg/hour PLRS is given for patients with
actual or estimated body weight of <50 kg, and 1.5 - 2 ml/kg/hour PLRS is
given for patients with actual or estimated body weight of >50 kg.

 Additionally, ongoing losses should be replaced volume per volume with
PLRS boluses or ORS (if tolerated).
CASE DISCUSSION
IV. PREVENTION HEALTH
PROMOTION

In order to prevent future recurrence of ACUTE INFECTIOUS

DIARRHEA which can lead to AKI, patient is advised on :
• Proper hygiene such as handwashing, and proper food

handling
• A healthy and balanced diet
• Proper exercise
CASE DISCUSSION
V. REFERENCES

1. The CPG on Management of Acute Infectious Diarrhea in Children and

Adult. 2019 update.
2. Harrison’s Principles of Internal MedicinE. 20TH Edition

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CASE PRESENTATION ON

ACUTE KIDNEY INJURY

PRIMARY DIAGNOSIS: Acute Kidney Injury

SECONDARY DIAGNOSIS: AGE prob sec to

A. ACUTE KIDNEY INJURY

• Prerenal AKI is the most common form of AKI. It

• Intrinsic AKI is commonly caused by sepsis,

• PostRenal AKI occurs when the normally

B. ACUTE INFECTIOUS DIARRHEA

Blood pressure Normal Orthostatic Shock

Respiratory rate Normal 21 - 25 ≥25

Pulse rate (beats ≥80 ≥100 Faint or thready

Peripheral Warm extremities Cold, clammy skin

Level of Alert Lethargic Coma or stupor

• In some patients, however, trophozoites may either invade Symptomatic

Certainty Treatment modality

1. AKI sec to Acute Infectious 80% Treat underlying cause

2. Amoebiasis 50% Treat underlying cause

Benefit Risk Cost Availability

3. Stool exam To assess for possible increased in No risk 30 available

4. Serum Na, K Assess possible electrolyte No risk 200 available

 For the antibiotic regimen:

 Fluid resuscitation is also needed to address the dehydration of the

In order to prevent future recurrence of ACUTE INFECTIOUS

• Proper hygiene such as handwashing, and proper food

1. The CPG on Management of Acute Infectious Diarrhea in Children and

2. Harrison’s Principles of Internal MedicinE. 20TH Edition

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