Clinical Case Senario
A 47-year-old cystic fibrosis patient, 1 week post–lung transplant, develops worsening creatinine (2.5 mg/dL from baseline 0.8mg/dl). He received 200 g IV mannitol intra-operatively for cerebral oedema prophylaxis in view of large volume resuscitation during intraoperative period. He also underwent CT pulmonary angiography 72 hours back to rule out pulmonary embolism for persistent hypoxemia.
Immunosuppression: tacrolimus (trough 9ng/ml), azathioprine, prednisone.
Urine output: 3 L/day.
Labs:
- Serum Na: 155 mEq/L
- Serum Osm: 330 mOsm/kg
- Urine Osm: 280 mOsm/kg
- Urine Na: 20 mEq/L
- FeNa: 1.5%
- Urine microscopy: tubular epithelial cells with cytoplasmic vacuolization
- Serum glucose: 110 mg/dL
Most likely cause of AKI?
