Very interesting teaching point occurred yesterday. We have a patient with long standing diabetes mellitus and known CKD Stage III. We admit him for increasing dyspnea – probably secondary to his COPD. I notice that his creatinine had run around 2.5, but now was around 1.3. These values had multiple repeats 6 months ago and currently.
So the puzzle for today – why did his creatinine improve so dramatically?
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Did someone review his medications and replace a loop diuretic in the past 6 monhts?
I bet you are going to say it was because he lost muscle mass but that can't be it. He was probably taken off and ACE/ARB or diuretic.
He was massively fluid overloaded from an exacerbation of CCF
OR- was he put on prednisolone which for some reason treated his stage III CKD, resulting in a sudden improvement of renal function???