Anuric Alan — Acute Kidney Injury
Urine < 30 mL/hr, K⁺ ↑, creatinine ↑ — find the cause first
Alan had a CT with contrast on Monday and takes ibuprofen most days. By Wednesday his ankles are swollen, he is short of breath, and the collection container by the bed is nearly empty.
Alan's kidneys stop making urine. Prerenal means poor perfusion, intrarenal means damaged tissue (contrast dye, NSAIDs, aminoglycosides), postrenal means obstruction. Potassium climbs, creatinine climbs, fluid backs up into his lungs. Urine output under 30 mL/hr is the number that starts everything.
Read Anuric Alan's full story →The story arc
The setup
Contrast dye, daily NSAIDs and a bout of vomiting that left him dry — three insults to the same kidney.
The turn
Urine output falls to 20 mL/hr, creatinine doubles in 48 hours and BUN climbs with it.
The crisis
Potassium is 6.3 with peaked T waves, crackles fill both bases, and his weight is up 4 kg in two days.
The save
Nephrotoxins are stopped, fluids and potassium are restricted, insulin with dextrose shifts potassium in while sodium polystyrene removes it, and daily weights track the fluid.
NCLEX study section — Acute Kidney Injury
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.