Question

Please answer questions fully, and organized! Will give good rating.

J. S. is 23 years old. He was brought to the emergency department after an auto accident. He suffered a concussion and a deep laceration of his right thigh. He lost about 4 units of blood prior to effective control of bleeding and closure of the wound. Fluid resuscitation is initiated, and a urinary catheter is inserted post operation to monitor his urine output. However, he continues to have significant oozing from his sutured wound.

His 24-hour urine volume is 350 ml with a high urine osmolality and low urine sodium. A coagulation screen results indicate the following: platelet count 250,000, bleeding time and a PTT time are both extended.

1. What type of renal failure is J. S. developing? Why is this type of renal failure developing?
2. If J. S. does not receive adequate treatment, what further condition may he develop? Why? What is the best treatment option to prevent this from occurring?
3. What other laboratory data beside urine output should be collected to evaluate J. S.'s renal function?
4. If J. S.’s renal function continues to be diminished without any improvement, what could be the subsequent stages of his renal disorder?

Answer 1

1) J.S developing the  prerenal azotemia . He has low sodium level and high osmolarity , this shows the high concentration of urine with insufficient amout of water . Prerenal azotemia develops in case when there is the excess nitrogen compond in the blood of a patient and sometime it is due to the lack of oxygen flow to the kidney . This prerenal azotemia is a kind of acute prerenal renal faliure .

2) If J. S. does not receive adequate treatment the further consequences of this acute prerenla issue will lead to the intrinsic acute kidney injury that is itrarenal . Kidney start lossing its function if the adequate treatment is not provided and sometime in severe cases it will lead to Acute tubular necrosis.

The best treatment option to prevent this occuring is adequate extracellular volume replacement of blood or isotonic fluids to ensure that maintain the circulating volume , And we can use dialyisis as therapy to maintain the artereal blood pressure and perfussion pressure to the kidney .

3) in addition to the urine output , the other laboratory data should be monitored to evaluate he J.S renal functioning . The data includes , serum BUN , creatine and potassium levels should be monitored , and if these are found to be increased then the renal function gets down . Creatine clearance is also very important to evaluate to checck that the glomerular filtration rate should be adequate and proper . The sodium level in the serum is a key factor that has to be evaluated to determine the correct IV fluid composition to the administer .

All these data should be evaluated to examine the renal functioning of J.S along with the urine output .

4) If J. S.’s renal function continues to be diminished without any improvement, then it  could be lethal at the subsequent stages of his renal disorder . It will develop the Lethargy ,Weakness ,Shortness of breath ,Generalized swelling (edema) ,Generalized weakness due to anemia , Loss of appetite , Fatigue , Congestive heart failure , Metabolic acidosis , High blood potassium (hyperkalemia) , Fatal heart rhythm disturbances (arrhythmias) including ventricular tachycardia and ventricular fibrillation , Rising urea levels in the blood (uremia) may lead to brain encephalopathy, pericarditis (inflammation of the heart lining), or low calcium blood levels (hypocalcemia) . In severe and long term untreated cases , it will convert into chronic renal faliure and sometime lead to the death .

With chronic condition it will be more diificult to get well soon with so much of traumal injuries soon , and in some cases the situation is not undercontrolled of anyone and it will cause death.