RENAL PROBLEMS AND CRITICAL CARE Solution 9

This patient has a multitude of risk factors for renal injuries. At baseline, his kidneys are probably abnormal, with his history of hypertension and diabetes. In addition, he has lost a considerable amount of blood, so he may have a pre-renal issue on top of chronic renal impairment. The icing on the cake, however, is that this patient has had no less than 4 potential nephrotoxins: a radiographic dye, a non steroidal anti-inflammatory agent, an aminoglycoside and an ACE inhibitor, one after the other. The diagnosis is therefore, acute renal failure due to baseline disease, hypovolemia and nephrotoxins.

The purpose of giving you this scenario is to point out that many of the interventions which we perform can injure the kidneys, particularly if pre-existent disease is present.

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