Question

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

Answer: As mentioned in the case, the patient was brought to the ED due to the accident and he lost 4 units of blood already. This causes development of the hypovolemic shock. This causes reduced flow of blood in to the kidney which caused kidney failure. Additionally, the perfusion rate also decreases.

Already, the perfusion rate is low and if the treatment would not be provided instantly, it would cause acute kidney injury. This will directly increase the levels of urea, potassium as well as creatinine in the blood. This will cause blood to become more acidic.

The only treatment could be given is the instant blood transfusion and fluid replacement therapy. Further, if no improvement occurs then patient would require dialysis. The test for Urea, creatinine levels should be performed.