Reconstructive surgery and perioperative broad-spectrum antibiotics

Case Study A healthy 26-year-old woman sustained a significant crush injury to her right upper extremity while on the job at a local construction site. She was brought to the emergency department and subsequently underwent pinning and reconstructive surgery and perioperative broad-spectrum antibiotics. Her blood pressure remained normal throughout her hospital course. On the second hospital day, a medical consultant noted a marked increase in her creatinine, from 0.8 to 1.9 mg/dL. Her urine output dropped to 20 mL/h. Serum creatine kinase was ordered and reported as 3400 units/L.

1. ‘Explain how muscle damage sustained in the crush injury would result in acute kidney injury in this patient.

2. Kidney injury can be categorized into prerenal, intrarenal, and postrenal. Which two types of kidney injury are most likely in this patient?

3. How should the patient be treated?

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