Answer:
1. Severe dehydration
2. Investigations required will include serum urea, electrolytes and creatinine (U/E/Cr), full blood count and differentials, urinalysis, urine microscopy, culture and sensitivity, renal ultrasound, random blood glucose.
3. Deranged U/E/Cr that is urea, creatinine and sodium are elevated which indicate kidney injury. There is proteinuria, haematuria, positive nitrate and leucouria points towards UTI. The WBC is high which indicate infection.
5. She is likely to have prerenal AKI
6. The concern is that she is not regular on her antihypertensive medication, and hypertension can cause renal impairment ( hypertensive nephropathy). There is need for dialysis if there is markedly elevated E/U/Cr or renal impairment was very severe.
Explanation:
Acute kidney injury is when there is sudden and often reversible loss of renal function which develops over days or weeks and is usually accompanied by a reduction in urine output.
There are many causes of AKI, which are classified as prerenal, renal and post renal. In prerenal AKI, the kidneys gets damaged as a result of hypoperfusion leading to acute tubular necrsosis. Common examples are severe dehydration( like in this patient from vomiting), cardiac failure, sepsis, blood loss etc. Renal AKI is usually cause by direct insult to the kidneys which can result from drugs, toxins, inflammatory conditions etc. Post renal AKI occurs when there is obstruction to urine flow at any point from the tubule to the urethra e.g in BPH, stones, strictures etc.
In Prerenal AKI, it leads to acute tubular necrosis. Histologically, the kidney show inflammatory changes, focal breaks in the tubular basement membrane and interstitial oedema.
Chronic kidney disease(CKD) refers to an irreversible deterioration in renal function which develops over a period of years.initially, it is manifestation only as biochemical abnormality but eventually, loss of the excretory, metabolic and endocrine functions of the kidneys leads to clinical symptoms and signs of renal failure.
