The Clinical Problem Solvers Episode 417 – RLR – A unique AKI
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Sep 1, 2025 Join a lively conversation that starts with birthday celebrations and transitions into the complexities of Meg's syndrome, a benign mimic of metastatic cancer. The hosts tackle the tricky waters between acute kidney injury and chronic kidney disease, using illustrative cases to highlight diagnostic challenges. A detailed case study on bilateral hydronephrosis showcases the importance of imaging and clinical intuition. Finally, the discussion takes twists to connect renal issues with broader organ dysfunction, revealing critical health insights.
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Always Recheck Surprising Labs
- Repeat unexpected lab abnormalities before acting and reconcile them with the clinical exam.
- Prioritize checking meds, bladder scan, and basic volume status to rule out common reversible causes.
Electrolytes Reveal Acute vs Chronic
- Hyperkalemia alongside rising creatinine strongly suggests reduced renal excretion rather than lab error.
- Electrolyte abnormalities and PTH/vitamin D can help distinguish acute versus chronic kidney disease.
Straight Catheter Use Hid Urine Output Clues
- The patient self–straight cathed three times daily after a bladder repair and couldn't estimate urine volume.
- His random bladder scan in the ED measured only 17 cc after he had just catheterized.