A 71-year-old man with a history of colon cancer status post right hemicolectomy with colostomy 6 months earlier, presented with a 3-day history of orthostatic dizziness. He reports that the content of the colostomy bag over the last 5 days has been watery, foul smelling, and has to be emptied every 2–3 h. He has diabetes mellitus, hypertension, and chronic kidney disease and is treated with metformin and enalapril. His blood pressure and pulse while lying down were 96/75 mmHg and 96 beats per minute (bpm), respectively. Standing up his blood pressure was 80/65 mmHg and his pulse was 112 bpm. His oral mucosa and axillae were dry, neck veins were not distended, lungs were clear, and he had no ventricular gallops. At admission his serum creatinine was 4.1 mg/dL (up from his baseline of 1.8), urine Na was 35 mEq/L, and fractional excretion of sodium (FENa) was 1.76.
KeywordsChronic Kidney Disease Acute Kidney Injury Renal Blood Flow Acute Tubular Necrosis Renal Perfusion
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