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Acute Renal Failure Case Study

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1. What are possible factors predisposing Mr. K. G. for acute renal failure?

Possible predisposing factors for Mr. K.G. include his past medical history of hypertension and diabetes mellitus type 2, which can cause renal ischemia and cell injury (Moore, 2013). His myocardial infarction two years ago is also a predisposing factor because it has reduced his cardiac output, which could result in hypoperfusion of the kidneys. Mr. K.G.’s age also puts him at risk since after age 40, “renal blood flow gradually diminishes at a rate of 10% per decade” (Sole et al., 2013, p. 434). Additionally, decreased renal mass, number of glomeruli, and peritubular density often occur with advanced age (Sole et al., 2013). Mr. K.G. takes an NSAID and an ACE inhibitor,
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Creatinine level is used to evaluate kidney function because creatinine is a byproduct of muscle metabolism that is produced at a constant rate and is cleared by the kidneys (Sole et al., 2013). When there is a decrease in kidney function or a decrease in GFR, creatinine levels increase. Serum blood urea nitrogen (BUN) can also be used to evaluate kidney function because urea is a byproduct of protein metabolism and is elevated when kidney function is compromised. However, BUN is not as reliable as serum creatinine because the rate of protein metabolism is not constant (Sole et al., 2013). External factors that can cause an elevated BUN include dehydration, starvation, high- protein diet, corticosteroids, blood in the GI tract, and fever (Sole et al., 2013, p. 442). The BUN/creatinine ratio can also be evaluated, with normal ranges between 10:1 and 20:1 (Sole et al., 2013). Pre-renal conditions can also lead to a high BUN/creatinine ratio, such as dehydration. In a patient with acute tubular necrosis, the BUN/creatinine ratio will remain at a normal range because both BUN and creatinine are elevated together (Sole et al., 2013). This is was we see for Mr. K.G., whose ratio is 20:1. Urine tests could also be useful to assist in the diagnosis of acute renal failure, but should be completed before diuretic therapy is initiated. Urine electrolytes, specific gravity, and osmolality can …show more content…
K.G. had predisposing factors for acute renal failure, prevention would have been the best intervention. This would include taking steps to eliminate contributing factors, such as strict regulation of blood pressure, regulation of acid-base balance, ensuring adequate nutrition, and maintenance of optimal volume status (Sole et al., 2013). Optimal volume status is achieved using normal saline when the patient has more than 40mL/hr urinary output and a mean arterial pressure above 80 mm Hg (Sole et al., 2013). Since Mr. K.G. required radiocontrast media for his cardiac catheterization, extra measures should have been taken to prevent contrast-induced nephropathy. This would include limiting the contrast volume to less than 100 mL of iso-osmolar radiocontrast media, adequate hydration before and after the procedure, and stopping the use of his aspirin and Lisinopril prior to his procedure (Sole et al., 2013). Fenoldopam should have been given as an IV infusion before and after his cardiac catheterization because it dilates the renal arteries and improves blood flow to the kidneys (Moore,

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