mmizellCan you explain why it wouldn't be AIN due to the amoxicillin (PCNs can cause AIN).
I understand ACEIs/ARBs decrease renal blood flow and lead to a transient increase in creatinine after starting, but that would classify this AKI as pre-renal and the BUN:Cr isn't consistent with that. (I calc 11ish, which is less than 20, making me think intrarenal or post-renal). She isn't having hematuria or flank pain, or other signs of decreased urine output, so I reasoned it would be intra-renal, thus AIN due to the amoxicillin.+4
len49+Hyaline cast - nonspecific, but often seen in concentrated urine specimen like someone who has an AKI, you would expect for AIN WBC cast that hyaline ones. +1
bmd12Along with what len49 said, another reason to think that this issue is due to the ACE - and not amoxicillin is that as soon as the ACE- was given, BP increased along with increased BUN/Cr. The pt already has a super high bp so the fact that it increased even more is concerning for stenosis. Also AIN presents with fever, rash, eosinophils along with WBC casts+
submitted by โbwdc(697)
Acute kidney injury with volume overload, presumably from the ACE-inhibitor.