A female adult client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
A. Blood urea nitrogen (BUN) level of 22 mg/dl.
B. Serum creatinine level of 1.2 mg/dl.
C. Temperature of 100.2° F (37.8° C).
D. Urine output of 400 ml/24 hours.
Correct Answer: D. Urine output of 400 ml/24 hours
ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is demonstrated by a urine output of 400 ml/24 hours. Renal causes of oliguria arise as a result of tubular damage. As a result of the tubular damage, the kidney loses its normal function i.e., production of urine while excreting the waste metabolites.
Option A: BUN level of 22 mg/dl does not indicate ARF. Urea, in contrast to serum creatinine, is not secreted but is reabsorbed by the renal tubules. The increased reabsorption of sodium and water, rather than the reduced GFR, enhances reabsorption of urea and increases BUN levels.
Option B: A serum creatinine level of 1.2 mg/dl isn’t diagnostic of ARF. Acute renal failure occurs when the serum creatinine level increases by 0.5 mg/dL or more within 2 weeks or less. In cases of chronic kidney disease where the baseline creatinine is greater than 2.5 mg/dL, a 20% increase from baseline is required.
Option C: A temperature of 100.2° F (37.8° C) wouldn’t result from this disorder. The decrease in renal blood flow (prerenal azotemia): Prerenal AKI occurs secondary to either an absolute reduction in extracellular fluid volume or a reduction in circulating volume despite a normal total fluid volume, e.g., in advanced cirrhosis, heart failure, and sepsis.
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