Case Published: December 2021
Case Submitted By: NephSIM Nephrons Tubule 11: Distal Convoluted Tubule (2021)

Trainees: Albert Bui, Harsha Adnani, Alessandra Tomasi, Megan Chalupsky, Mario Suito, Carmen Cajina, Vipin Varghese
Faculty Mentors: Matthew Sparks, Meera Harhay, Roslyn Mannon

History of Present Illness (HPI)

A 49-year-old woman with a history of symptomatic cavernous hepatic hemangiomas, asthma, and gastroesophageal reflux disease (GERD) presents with an elevated serum creatinine (Cr) of 1.9 mg/dL (baseline: 0.8 mg/dL two weeks ago) 1 day after a radiofrequency ablation (RFA) of a hepatic hemangioma. 150 mL of intravenous contrast was was administered at the conclusion of the procedure to confirm the ablation zones. Estimated blood loss during the procedure was 50 mL. She remained normotensive during the procedure. Of note, all laboratory studies performed 2 weeks prior to the procedure were within the normal range, including a complete blood count and basic metabolic panel. 

She received 1 dose of intravenous ketorolac 30 mg on post-operative day (POD) 1 for post-operative pain. No additional pain medications were given. Today, she feels fine and does not have fever, nausea, vomiting, chest pain, shortness of breath, diarrhea, or urinary symptoms. 

Despite isotonic fluid resuscitation, Cr rose to 3.9 mg/dL (POD 2) → 4.9 mg/dL (POD 3). She made minimal urine (<200 mL per 24 hours measured via Foley catheter). A furosemide stress test did not yield a significant increase in urine output and she remained oliguric. 

Her only current medication is esomeprazole 40 mg twice daily, which she has taken for many years. She does not take non-steroidal anti-inflammatory (NSAID) medications for pain.

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