The most common early sign of kidney disease is:
A. Sodium retention
B. Elevated BUN level
C. Development of metabolic acidosis
D. Inability to dilute or concentrate urine
Correct Answer: B. Elevated BUN level
Increased BUN is usually an early indicator of decreased renal function. Although, immediately after a renal insult, blood urea nitrogen (BUN) or creatinine levels may be within the normal range. The only sign of the acute kidney injury may be a decline in urine output. AKI can lead to the accumulation of water, sodium, and other metabolic products. It can also result in several electrolyte disturbances.
Option A: Evaluation of AKI should include a thorough search for all possible etiologies of AKI, including prerenal, renal, and post renal disease. The timing of the onset of AKI can be especially helpful when dealing with hospitalized patients. For example, if a patient’s labs are being checked every day and creatinine suddenly starts to rise on the fourth day of admission then an inciting factor can usually be found in 24-48 hours preceding the onset.
Option C: The impetus for glomerular filtration is the difference in the pressures between the glomerulus and the Bowman space. This pressure gradient is affected by the renal blood flow and is under the direct control of the combined resistances of afferent and efferent vascular pathways. Nevertheless, whatever the cause of AKI, renal blood flow reduction is a common pathologic pathway for declining glomerular filtration rate.
Option D: The prerenal form of AKI is because of any cause of reduced blood flow to the kidney. This may be part of systemic hypoperfusion resulting from hypovolemia or hypotension, or maybe due to selective hypoperfusion to the kidneys, such as those resulting from renal artery stenosis and aortic dissection.
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