Case of AKI

  

A 56-year-old man presented to the emergency room (ER) with complaints of chest pain and shortness of breath. The patient reported a sudden experience of tightness in his chest while doing yard work 4 hours prior to the ER visit. He has subsequently been experiencing episodes of nausea and periods of coughing. His past medical history is significant for hypertension, type 2 diabetes mellitus, and hypercholesterolemia. His current home medications are metoprolol, metformin, and simvastatin; his wife pointed out that he does not take his medications regularly. 
He has no known allergies. 
He smoked 30 packs of cigarettes per year for the past 30 years, and consumes 2 to 3 glasses of wine per day in addition to 2 cups of coffee. The patient denies any history of recreational drug use.
 The patient does not exercise regularly. 

In this case, a patient presented to the emergency department with symptoms characteristic of a myocardial infarction and subsequently underwent emergency CABG surgery. Following surgery, the patient remained relatively stable on the first postoperative day. By day 2, the patient had become oliguric and elevations in serum BUN and creatinine were noted. Despite volume challenges, these levels rose for a second day. A diagnosis of AKI was made, most likely secondary to multiple insults: hypotension, radiocontrast dye, and cardiac surgery. Approximately 5% to 15% of patients undergoing cardiac surgery with the use of cardiopulmonary bypass have AKI, and roughly 10% of these cases require dialysis. The in-hospital mortality rate associated with postoperative AKI requiring dialysis is upwards of 35% with a 2-year survival rate less than 20%.

Multiple mechanisms could have contributed to the patient's AKI. First, he presented with hypotension in the ER. Second, he received contrastAKI remains a common disorder among critically ill patients. It is therefore imperative that preventive measures such as restoration of intravascular volume status, maintenance of adequate renal perfusion pressures, and limiting exposure to nephrotoxins should be undertaken.

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