ATN without AKI?

[Antoine Dodson]

Recently consulted on an OB patient with dark colored urine and slightly elevated Cr (1.06) v baseline of .9. GFR dropped from 88 to 72. All of this in setting of pre-elampsia and then C-section. Patient was also given Toradol. Patient was non-oliguric. OB ordered FENa and it came to >4 and medicine then consulted. Can anyone comment on this? I'm not sure why FENa ordered or even its utility in this context, without an AKI.

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[Hamhock]

Recently consulted on an OB patient with dark colored urine and slightly elevated Cr (1.06) v baseline of .9. GFR dropped from 88 to 72. All of this in setting of pre-elampsia and then C-section. Patient was also given Toradol. Patient was non-oliguric. OB ordered FENa and it came to >4 and medicine then consulted. Can anyone comment on this? I'm not sure why FENa ordered or even its utility in this context, without an AKI.

What was the question for the consult?

Why is my patient's urine dark?

HH

 

[Antoine Dodson]

Basically, yes. The OB went ahead and ordered and calculated the FENa after noting the dark urine and the "bump" in Cr. When OB saw it was >4%, consulted with concern for ATN.

 

[ArkansasMed]

Recently consulted on an OB patient with dark colored urine and slightly elevated Cr (1.06) v baseline of .9. GFR dropped from 88 to 72. All of this in setting of pre-elampsia and then C-section. Patient was also given Toradol. Patient was non-oliguric. OB ordered FENa and it came to >4 and medicine then consulted. Can anyone comment on this? I'm not sure why FENa ordered or even its utility in this context, without an AKI.

Fractional excretion of sodium is only useful in oliguria. This explains the odd findings you had.

I would not call 0.9 to 1.1 an AKI. That could just be lab measurement error.... Definition of an AKI in the absence of oliguria is either 0.3 or greater increase and/or 1.5 increase at baseline. Hope this helps.