Update: one of the comments asked about the patients body habitus, rhabdo and BUN.This patient had a remote diagnosis of hypertension but had been out of any medications for months. The computer showed a 2 year old creatinine of 2 but the patient denied any memory of being told he had CKD.
- Mr S. is muscular but no body builder
- He was not in rhabdo. I would not include an elevated creatinine due to muscle breakdown under the crazy numbers tag as it essentially represents a lab error, in that the creatinine is no longer a measure of severity of the renal failure or the chronicity but rather a measure of the aggregate muscle damage.
- His BUN was 139 mg/dL
One of my co-fellows, Rajiv Poduval, used to call this acute ESRD. Chronic kidney disease that goes unrecognized until the patient rolls into the ED in need of dialysis.