Nephrology Expert Opines on Allegedly Premature Discharge of Patient With Kidney Injury

This case involves a middle aged male patient who had underwent bariatric surgery and subsequently developed a kidney injury following a bout of sepsis. Upon discharge, it was noted that his creatinine levels were elevated. The patient followed up with his nephrologist and complained of persistent nausea. The man was then seen by another doctor, who ordered an upper GI series in order to determine the cause of his symptoms. Shortly after the test was performed, the patient suffered a cardiac arrest and died.

Question(s) For Expert Witness

1. How often do you manage patients with an acute kidney infection?

2. What is the appropriate course of action if a patient develops elevated creatinine levels?

3. During a follow-up visit, what are the labs or imaging you'd order?

Expert Witness Response E-009201

In trying to determine the cause of the cardiac arrest I would be interested in what monitoring took place post discharge. In particular what were the labs at the follow up and preprocedure, what was the patients volume status. Also, trends in labs and clinical status around time of discharge may provide clues as to why she had the cardiac arrest. Role of comorbidities, medications and peri-endoscopy events will also be relevant. I manage patients with AKI and ATN very frequently. When covering inpatients these types of patients are very common and we see several daily. Treatment depends somewhat on the underlying cause. First would be to treat underlying disorder. Then avoid further insults. Ultimately we monitor for recovery in this context - monitoring patient volume status, mental status, urine output, creatinine and electrolytes. The patient may need supportive therapy with diuretics or dialysis if severe acute kidney injury. At a minimum a basic or comprehensive metabolic panel to assess BUN/creatinine, potassium, bicarbonate. Imaging may not be necessary.