We asked out hospitalist about the feasibility of querying for these. they said they would need a renal biopsy to make those determinations.
Stacy Vaughn, RHIT, CCS Data Support Specialist/DRG Assurance Aurora Baycare Medical Center 2845 Greenbrier Rd Green Bay, WI 54311 Phone: (920) 288-8655 Fax: (920) 288-3052
For reference , see this piece on ATN that comes from e-medicine.medscape, From the article it appears that a biopsy is not necessary to make the diagnosis of ATN but rather it is a clinical diagnsis
Biopsy is rarely necessary. It should be performed only when the exact renal cause of ARF is unclear and the course is protracted. Prerenal and postrenal causes must be ruled out first. The diagnosis of ATN is made on a clinical basis, that is, with the help of a detailed and accurate history, a thorough physical examination, and pertinent laboratory examinations and imaging studies. A more urgent indication for renal biopsy is in the setting of clinical and urinary findings that suggest renal vasculitis rather than ATN; the diagnosis needs to be established quickly so that appropriate immunomodulatory therapy can be initiated. The biopsy is performed under ultrasound or CT scan guidance after ascertaining the safety of the procedure. A biopsy may also be more critically important in the setting of a renal transplant patient to rule out rejection.17,18
I will use this as an educational piece. But they are not interested in a query for the MCC's of renal failure and wanted to divert to nephrology. (which is not a regular consult)
Stacy Vaughn, RHIT, CCS Data Support Specialist/DRG Assurance Aurora Baycare Medical Center 2845 Greenbrier Rd Green Bay, WI 54311 Phone: (920) 288-8655 Fax: (920) 288-3052
Differentiation from prerenal azotemia, based mainly on laboratory findings and, in the case of blood or fluid loss, response to volume expansion
ATN is suspected when serum creatinine rises ≥ 0.5 mg/dL/day above baseline after an apparent trigger (eg, hypotensive event, exposure to a nephrotoxin); the rise in creatinine may occur days after exposure to some nephrotoxins. ATN must be differentiated from prerenal azotemia because treatment differs. In prerenal azotemia, renal perfusion is decreased enough to elevate serum BUN out of proportion to creatinine, but not enough to cause ischemic damage to tubular cells.
I have asked our Nephrologists to document the etiology/significance of the ATN so we know what he/she is thinking to make the diagnosis. Has really been good about this. Thanks Colleen Stukenberg
Comments
said they would need a renal biopsy to make those determinations.
Stacy Vaughn, RHIT, CCS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052
http://emedicine.medscape.com/article/238064-diagnosis
Procedures
Biopsy is rarely necessary. It should be performed only when the exact renal cause of ARF is unclear and the course is protracted. Prerenal and postrenal causes must be ruled out first. The diagnosis of ATN is made on a clinical basis, that is, with the help of a detailed and accurate history, a thorough physical examination, and pertinent laboratory examinations and imaging studies. A more urgent indication for renal biopsy is in the setting of clinical and urinary findings that suggest renal vasculitis rather than ATN; the diagnosis needs to be established quickly so that appropriate immunomodulatory therapy can be initiated. The biopsy is performed under ultrasound or CT scan guidance after ascertaining the safety of the procedure. A biopsy may also be more critically important in the setting of a renal transplant patient to rule out rejection.17,18
query for ATN as well.
N. Brunson, RHIA, CCDS
I will use this as an educational piece. But they are not interested in
a query for the MCC's of renal failure and wanted to divert to nephrology.
(which is not a regular consult)
Stacy Vaughn, RHIT, CCS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052
Thanks!
Leah Taylor,RN, CCDS
557 Brookdale Drive
Statesville, NC 28625
E- leah.taylor@iredellmemorial.org
c- 704-878-7436
http://www.merck.com/mmpe/sec17/ch236/ch236b.html#CHDEFFGJ
(there is a nice little table with the lab values as well)
Differentiation from prerenal azotemia, based mainly on laboratory findings and, in the case of blood or fluid loss, response to volume expansion
ATN is suspected when serum creatinine rises ≥ 0.5 mg/dL/day above baseline after an apparent trigger (eg, hypotensive event, exposure to a nephrotoxin); the rise in creatinine may occur days after exposure to some nephrotoxins. ATN must be differentiated from prerenal azotemia because treatment differs. In prerenal azotemia, renal perfusion is decreased enough to elevate serum BUN out of proportion to creatinine, but not enough to cause ischemic damage to tubular cells.
Thanks
Colleen Stukenberg
About Dawn's comment -- agreed, great resource, I simply forgot about that (one of the multiple sessions where I had tough choices to make).
Don