A healthy 26-year-old woman sustained a significantcrush injury to her right upper extremity while on the job at alocal construction site. She was brought to the emergencydepartment and subsequently underwent pinning and reconstructivesurgery and received perioperative broad-spectrum antibiotics. Herblood pressure remained normal throughout her hospital course. Onthe second hospital day, a medical consultant noted a markedincrease in her creatinine, from 0.8 to 1.9 mg/dL. Her urine outputdropped to 20 mL/h. Serum creatine kinase was ordered and reportedas 3400 units/L.
Questions
What are the primary causes of this patient’s acutekidney injury? How should her kidney injury be categorized (asprerenal, intrarenal, or postrenal)?
How should she be treated?
