Chronic Renal Failure – Case Study 2 of 6 Based on the history provided, highlight in the table the correctly matched factor with the cause that predisposed the client to the current problem.
Notes
Last year she was admitted three times: with pyelonephritis infection, but she did not complete the antibiotic dosage; with streptococcal infection of the wound and was treated with high dose gentamicin; and with kidney stones, for which she underwent irrigation to remove the renal calculi. She was recently admitted to labor, which complicated a severe postpartum hemorrhage and caused her to lose too much blood. Unfortunately, she only received one unit that was available in the blood bank.
Vitals
| Diagnostic Test | Result | Normal |
| Creatinine clearance test | 15 ml/min | 125ml/min |
| Blood Urea Nitrogen (BUN) | 45 mg/dl | 10-20 mg/dl |
| Serum creatinine level | 3.0mg/dl | 0.5-1.1mg/dl |
| Blood cell count | RBCs: 2.5 million cells/mcL WBCs: 7,500 cells/mcL Hgb: 9.5 gm/Dl Platelet: 130,000/dL | RBCs: 4.2–5.4 million cells/mcL WBCs: 4,500–10,000 cells/mcL Hgb: 12.1–15.1 gm/Dl Platelet: 150,000–450,000/dL |
Rationale
Correct: Pre-renal causes of kidney failure include dehydration, severe hemorrhage, cardiac failure, and shock. All these causes reduce the blood flow to the kidney. Intrarenal causes are those targeting and damaging the nephrons, which include toxins, medications- aminoglycosides, gentamicin), glomerulonephritis, and pyelonephritis. Post-renal causes are those as a result of outflow problems, which include obstruction caused by kidney stones.
Incorrect: Pyelonephritis and streptococcal infections are both intrarenal causes. A blood transfusion is not a cause.
