Acute Kidney Injury and Chronic Kidney Disease

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.

• What type of renal failure is J. S. developing? Why is this type of renal failure developing?
• 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?
• What other laboratory data beside urine output should be collected to evaluate J. S.’s renal function?
• If J. S.’s renal function continues to be diminished without any improvement, what could be the subsequent stages of his renal disorder?

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