University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Internal Medicine


Dr. Elyse Watkins



Purpose: The purpose of this case report is to discuss a patient with severe acute kidney injury (AKI) in the hospitalized setting, and to discuss appropriate workup and treatment of patients presenting with AKI. The article will discuss the evidence-based evaluation of AKI and explore potential ways to avoid unnecessary renal biopsy which can lead to procedural complications for patients and avoidable safety risks.

Method: A PubMed literature search was conducted using search terms including “Acute Kidney Injury” (AKI), “CRAB (Calcium, Renal failure, Anemia, Bone Lesions) criteria,” “Multiple Myeloma,” “SLIM-CRAB (Sixty percent, LIght chains, MRI lesions)” and “urinary biomarkers”. Eleven pertinent articles were retrieved and utilized as the basis for this case presentation article. The patient’s de-identified medical record was used as the basis for the clinical facts of the case. The patient verbally consented to her case being used in a case presentation.

Results: The patient ultimately underwent a renal biopsy which proved that she did not have multiple myeloma causing the acute renal failure, but rather she had severe diabetic nephropathy and progressed to end-stage renal disease (ESRD). The patient remained dialysis-dependent and removed herself from the renal transplant waiting list for unclear personal reasons.

Conclusion: The workup and management of acute kidney injury heavily relies on an astute clinician recognizing patients presenting with AKI and then using evidence-based approaches to effectively manage AKI. Early inclusion of nephrologists can be helpful if the diagnosis and etiology of renal failure are uncertain. Clinical evidence-based tools such as the CRAB and SLIM-CRAB criteria for multiple myeloma can be helpful guides for complex clinical decision making but should not be relied on exclusively.


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