RENAL PROBLEMS AND CRITICAL CARE

A 69 year old male with a history of hypertension and atrial fibrillation is admitted through the emergency room with a 6 hours history of a painful white leg. A large embolus is located in his internal iliac artery, with distal ischemia. He is brought to the operating room for embolectomy-revascularization. Just prior to induction his blood pressure is 200/100, and you administer esmolol. During the operation, esmolol is continued as a drip, until circulation to the affected limb is re-established, at which time his blood pressure temporarily falls, and rests at approximately 170/90, there are some simultaneous intermittent arrhythmias, mostly premature atrial and ventricular contractions, and a short run of ventricular tachycardia.

The patient is otherwise stable and is returned to the intensive care unit postoperatively. Pre-operatively his creatinine was 1.1. Six hours post-operatively it was 1.8. The next morning the patient becomes anuric with a  creatinine of 2.5. His potassium is 6.8, his phosphate 5.9. There is no evidence of post renal obstruction. His is started on continuous hemodiafiltration.

What was the cause of this patient’s renal failure and could it have been prevented?

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