Elevated Creatinine

Question 1

15yo girl with elevated creatinine: likely causes

Answer 1

• dehydration
• third-spacing and hypoperfusion == sepsis, SIRS
• acute tubular necrosis (TOXIC, damage to tubular cells) = Vanco, Gent, Contrast
• Acute interstitial nephritis (INFLAMMATORY/ALLERGIC, damage to interstitium) = NSAIDS, sulfa, Vanco, PCN/cephalosporins

Question 2

15yo girl with elevated creatinine: lethal causes

Answer 2

• glomerular disease (auto-immune)
• Recurrent UTI ==> kidney scarring
• Pyelonephritis = (1) post-renal, obstructive; (2) dehydration, (3) sepsis and hypoperfusion
• Ischemic damage due to ATN
• congenital anomaly limiting functional tissue
• lack of mobility == baseline low Creatinine

Question 3

Jillian is 15yo female with hx of myelominingocele and shunted hydrocephalus (s/p VP shunt, mitrofanoff) presenting with worsening HA over 2-3, identified as VP shunt malfunction. No reports of FND or mental status change from home. no abd pain, changes in urine, or CVA tenderness. Elevated creatinine. Has been treating HA with ibuprofen (400mg/day).

• consideration?
• physical exam

Answer 3

• hx of myelomeninocele == congenital cause of anatomic/functional urinary problems; risk of UTI
• chronic v. acute
• risk of infection

NSAIDs can cause damage
- AIN (interstitial/inflammation)
- (dose-dependent) vasoconstriction of afferent arteriole == decreased
==> esp if small child, dehydrated, RAS

PHYSICAL
- check MSK, signs of infection at mitrofanoff, skin exam, flank pain

Question 4

complications of myelomeningocele

Answer 4

• neurogenic bladder, UTIs
• partial/complete paralysis of legs (esp. with location of myelomeningocele being lower)
• bowel problems = GI disorders
• hydrocephalus
• meningitis
• learning disabilities
• latex allergies / skin problems

Question 5

AIN

• history
• pathophysiology
• presentation
• workup

Answer 5

HISTORY
- exposure to medications

PATHOPHYSIOGLOY
- inflammatory/allergic

PRESENTATION

• flank pain
• rashes (b/c inflammation)
• fever
• UA = eosinophils, white cells, WBC casts

US of kidneys = normal, or echogenic

PROGNOSIS

• decreased renal fx, permanent damage/scarring
• if stop meds == reversible

Question 6

Causes of chronic interstitial nephritis

Answer 6

• SLE

- Sjogrens