From the Research
Pre-renal acute kidney injury (AKI) typically does not present with costovertebral angle (CVA) tenderness. The clinical presentation of pre-renal AKI usually includes decreased urine output, elevated blood urea nitrogen (BUN) and creatinine levels, with a BUN-to-creatinine ratio often greater than 20:1 1. CVA tenderness is more characteristic of intrinsic kidney conditions like pyelonephritis or kidney stones rather than pre-renal causes. In pre-renal AKI, physical examination may reveal signs of volume depletion such as dry mucous membranes, decreased skin turgor, orthostatic hypotension, or tachycardia, but the kidneys themselves are not typically inflamed or directly damaged, which is why CVA tenderness is usually absent 2. Some key points to consider in the management of AKI include:
- Optimization of volume status and avoidance of nephrotoxic medications 3
- Crystalloids are preferred over colloids for most patients, and hydroxyethyl starches should be avoided 3
- Volume overload in the setting of AKI is associated with adverse outcomes, so attention should be paid to overall fluid balance 3 If CVA tenderness is present in a patient with AKI, clinicians should consider other diagnoses or a mixed etiology for the kidney injury 1. It is essential to note that AKI has a significant impact on patient's mortality and morbidity, and early identification of patients at risk for AKI or with acute kidney damage is crucial before renal function further deteriorates 1.