Nephrology Expert Opines on Allegedly Premature Discharge of Patient With Kidney Injury

ByJoseph O'Neill

Updated on

Nephrology Expert Opines on Allegedly Premature Discharge of Patient With Kidney Injury

Case Overview

This case involves a middle aged male patient who had underwent bariatric surgery and subsequently developed a kidney injury following a bout of sepsis. Upon discharge, it was noted that his creatinine levels were elevated. The patient followed up with his nephrologist and complained of persistent nausea. The man was then seen by another doctor, who ordered an upper GI series in order to determine the cause of his symptoms. Shortly after the test was performed, the patient suffered a cardiac arrest and died.

Questions to the Nephrology expert and their responses

Q1

How often do you manage patients with an acute kidney infection?

I manage patients with AKI and ATN very frequently. When covering inpatients these types of patients are very common and we see several daily.

Q2

What is the appropriate course of action if a patient develops elevated creatinine levels?

Treatment depends somewhat on the underlying cause. First would be to treat underlying disorder. Then avoid further insults. Ultimately we monitor for recovery in this context - monitoring patient volume status, mental status, urine output, creatinine and electrolytes. The patient may need supportive therapy with diuretics or dialysis if severe acute kidney injury.

Q3

During a follow-up visit, what are the labs or imaging you'd order?

At a minimum a basic or comprehensive metabolic panel to assess BUN/creatinine, potassium, bicarbonate. Imaging may not be necessary.

About the expert

This highly qualified expert has over 20 years of experience in nephrology. He received his BS in mathematics from the University of Miami and his MD from Johns Hopkins University. He went on to complete a residency in internal medicine and a fellowship in nephrology at Johns Hopkins University. He is board certified in nephrology and is a member of several professional organizations including the American Society of Nephrology, the National Kidney Foundation, the International AIDS Society, and the American College of Rheumatology. This expert has contributed over 50 publications to his field and serves on the editorial board for the Advances in Chronic Kidney Disease Journal and the Clinical Journal of the American Society of Nephrology. He formerly served as an assistant professor of medicine at Johns Hopkins University and as the medical director of the Johns Hopkins Davita Bond Street Unit. In addition, he formerly served as the nephrology fellowship director at Johns Hopkins. He currently serves as an associate professor of medicine at a medical school in Maryland and as the medical director of a university-affiliated nephrology clinic in Maryland.

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About the author

Joseph O'Neill

Joseph O'Neill

Joe has extensive experience in online journalism and technical writing across a range of legal topics, including personal injury, meidcal malpractice, mass torts, consumer litigation, commercial litigation, and more. Joe spent close to six years working at Expert Institute, finishing up his role here as Director of Marketing. He has considerable knowledge across an array of legal topics pertaining to expert witnesses. Currently, Joe servces as Owner and Demand Generation Consultant at LightSail Consulting.

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