Thanks to Scott for presenting a fascinating case of an 80M with well-controlled HIV and BPH who presented with AKI found to have bilateral hydronephrosis with resolution of his AKI with b/l nephrostomy tubes.
1. Obstructive uropathy is rare in young patients without LUTS. Consider deferring a renal ultrasound in the initial work up for AKI in these patients.
2. Both pre and post-renal causes of AKI have an abrupt response to treatment. Response to treatment [e.g., IVF or nephrostomy tube placement] may occasionally be more informative than a detailed analysis of existing laboratory data [e.g., FeNa]
3. Most Dx tests of kidney injury are of the urine [UA, Uprotein/Cr, urine Na]. Especially in patients with concomitant anemia or thrombocytopenia, don’t forget a crucial blood test: the peripheral smear looking for schistoscytes.
Here’s one approach to AKI