A patient is admitted after an episode of unresponsiveness secondary to syncope and urinary tract infection (UTI). The focus of treatment was directed at the syncope (CT of the head, cardiac work-up, etc.). During the admission, it is noted that the patient also had mild acute kidney injury (AKI) that was treated with intravenous hydration. The provider’s discharge diagnosis is syncope secondary to dehydration and AKI. Should AKI always be sequenced as the principal diagnosis, when a patient presents with an acute kidney injury and dehydration?
The sequencing of dehydration and acute kidney injury (acute renal failure) should be based on the reason for the admission. Query the physician regarding the principal reason that the patient was admitted, if the reason for the admission is not clearly documented. There is no rule that acute kidney injury should always be sequenced first.