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

He was brought to the emergency department after an auto accident. He lost about 4 units of blood prior and now he continues to have significant oozing from his sutured wound.

That's why he is developing Hypovolemic shock, which decreases blood flow to the kidney resulting in acute kidney failure. In hypovolemic shock blood pressure is also very low, which also decreases kidney perfusion.

His 24-hour urine volume is 350 ml with a high urine osmolality and low urine sodium. He is now in an oliguria state. If further treatment is a delay, he may develop acute kidney injury which will again elevate the urea, creatinine, and potassium in the blood and makes blood sever acidic.

Hypovolemia also can cause severe hypotension without treatment which will gain result in acute kidney injury. and tissue death.

We can start treatment from an immediate blood transfusion and fluid replacement therapy. Administer starch and albumin and continue iv flids. Insert a central venous and arterial catheter to measure CVP and ABP.

Investigate Blood urea, Blood creatinine, serum sodium, serum potassium to know kidney function. You can also investigate lactate and arterial blood gas to know tissue perfusion.

If renal function will not improve then the patient may need dialysis.