Abstract: PUB004
A Patient with a Record High Blood Urea Nitrogen Value Surviving Without Dialysis
Session Information
Category: Trainee Case Report
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Me, Hay Me, Westchester Medical Center, Valhalla, New York, United States
- Hooda, Urvashi, Westchester Medical Center, Valhalla, New York, United States
- Sen, Aditi A., Westchester Medical Center, Valhalla, New York, United States
- Mittal, Amol, Westchester Medical Center, Valhalla, New York, United States
- Connery, Michael, Westchester Medical Center, Valhalla, New York, United States
Introduction
The blood urea nitrogen (BUN) has limited value as an index of glomerular filtration rate to access kidney function. It can be increased not only in the setting of acute or chronic renal failure but also in hypovolemic state, gastrointestinal tract bleeding, high catabolic states, and by certain medications. Dialysis is the effective treatment for uremia. However, there is no consensus on when to initiate the dialysis for high BUN in acute kidney injury.
Case Description
A 64-year female with history of hypertension, hypothyroid, hyperlipidemia, alcohol use disorder, chronic kidney disease (CKD) with baseline creatinine of 1.5 mg/dl was admitted for head trauma after fall. Patient had poor intake and was noticed to be confused lately by family. No history of analgesic or herbal supplements usage was present. Laboratory results were significant for BUN of 298 mg/dl, Creatinine (Cr) of 13.5 mg/dl, serum potassium of 5.4 mEq/L, phosphate of 6.1 mEq/L and severe metabolic acidosis with serum bicarbonate of 10 mEq/l, anion gap of 33 mEq/L, lactate acid of 4.6 mmol/L. Creatine kinase level was 253 U/L. Urine studies showed no proteinuria, mild hematuria, without crystals. Urine electrolytes showed sodium of 23 mmol/l and chloride of less than 20 mmol/l. Corona virus disease 2019 (COVID-19) was negative both by polymerase chain reaction and antibody test. All the sepsis work up, urine toxicology and blood alcohol level were negative. Renal ultrasound showed normal bilateral kidney sizes. Patient was aggressively resuscitated with intravenous fluid including bicarbonate and her cognitive function improved without dialysis. Her BUN eventually decreased to 30 mg/dl and Cr to 1.26 mg/dl.
Discussion
CKD patients are susceptible to infection, dehydration and develop multiple episodes of acute on chronic renal injury, subsequently resulted in end stage renal disease. Our patient was taking metoprolol, lisinopril and hydrochlorothiazide for hypertension which could also have prompted her into hypovolemic state without adequate hydration. Early detection of the underlying cause is crucial and can prevent the unnecessary complications from dialysis. A few cases of strikingly high creatinine up to 61.3 mg/dl have been reported and survived with dialysis. Based on the review of literature, this is the highest reported BUN in acute on chronic renal failure patient who improved without dialysis.