Please refer to Chapter 28 and then answer all of the questions that follow the case study:

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?

Cite specific areas from your readings and research to support your ideas.

comment 1

1. What type of renal failure is J. S. developing? Why is this type of renal failure developing?

Based on the history and signs and symptoms, J.S has developed acute kidney injury—more specifically prerenal kidney injury which is progressing to acute tubular necrosis. Due to JS accident and severe blood loss (significant volume depletion), there is a reduction in kidney perfusion. The blood can’t be filtered in the kidneys so toxic substances accumulate in the body. Cells in the kidneys were not perfused which led to acute tubular necrosis (Banasik & Copstead, 2019). The body is trying to compensate by having excreted less sodium and water in the urine (hence hyperosmolar urine).

J.S. is showing signs of bleeding (blood oozing out from his sutures). DIC is ruled out because his coagulation studies show normal platelet count (decreased in DIC). His bleeding must be due to an underlying uremic syndrome which is also a factor to consider in acute renal injury. Uremia causes platelet dysfunction (Weigert & Schafer, 1998), not platelet destruction, which might explain his continuous bleeding.

1. 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?

Other than his uremic symptoms, J.S. might develop severe acid-base disturbances due to accumulation of toxic substances. Most concerning would be hyperkalemia where it would have negative effects to heart conduction which can lead to fatal arrythmias (Banasik & Copstead, 2019).

Uremia is an indication for dialysis (Malkina, 2019). This will help decrease the waste that built up in the body and also decrease the workload of the kidneys giving it more time to heal itself.

1. What other laboratory data beside urine output should be collected to evaluate J. S.’s renal function?

In addition to urine output, J.S. needs careful strict monitoring of his electrolytes (calcium, sodium, potassium, phosphate) and urinalysis to check for infection. BUN/Crea and GFR is needed to monitor kidney function (Malkina, 2019).

1. If J. S.’s renal function continues to be diminished without any improvement, what could be the subsequent stages of his renal disorder?

If J.S. does not receive adequate treatment, it can acute kidney injury can progress to chronic kidney injury and then to end stage renal disease (Banasik & Copstead, 2019). This happens when the nephrons could not get enough blood and nutrients for themselves which results to cell death. Unfortunately, once it reaches end stage renal disease, the damage is too much that the destruction of the nephrons becomes irreversible,

Reference

Banasik J. L. & Copstead, L. C. (2019). Pathophysiology(6th ed.). Elsevier, Inc.

Malina, A. (2019). Acute kidney injury (AKI). Merck Manual Professional Version. https://www.merckmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki

Weigert AL, Schafer AI. Uremic bleeding: pathogenesis and therapy. Am J Med Sci. 1998;316(2):94-104. doi:10.1097/00000441-199808000-00005

comment 2

1. What type of renal failure is J.S. developing? Why is this type of renal failure developing?

J.S has a renal acute failure. Renal Acute failure Acute renal failure can happen because of the immediate loss of kidney function to excrete the waste materials. The causing factors of acute renal failure is damage blood flow to the kidney due to the severe of blood loss, in which in this case J.S has lost a 4 units amount of blood.

2. If J.S. does not receive adequate treatment, what further condition may he develop? Why? What would be the best treatment option for preventing that from occuring?

If he does not receive adequate amount of treatment his condition will lead to complications. He could develop kidney failure, in which your kidneys are unable to filter waste products from your blood. The best treatment options would be doing a dialysis, in which it helps to take out the toxins from the blood until the kidney becomes normal. Also, Diuretics can help take out the unwanted fluid and edema from the body.

3. What other laboratory data beside urine output could be collected to evaluate J.S.’s renal function?

Other laboratories should include blood analysis for creatine test, image test such as CT Scan for the kidney, CBC and renal biopsy.

4. If J.S.’s renal function continues to be diminished without any improvement, what could be the subsequent stages of his renal disorder?

If J.S. Laboratory continues to be diminished it would result to a chronic kidney disease, which means that your kidneys are not working and it is damage, and unable to filter blood the way they should. In which in this case, dialysis and kidney transplant is necessary.

Reference:

Bhargava, Hansa D (2020, July 02). Acute Kidney Failure. Retrieved from https://www.webmd.com/a-to-z-guides/what-is-acute-kidney-failure#1

Centers For Disease Control and Prevention (2020, February 7). Chronic Kidney Disease Basics. Retrieved from https://www.cdc.gov/kidneydisease/basics.html