Which of the following clients is at greatest risk for developing acute renal failure?
A. A dialysis client who gets influenza.
B. A teenager who has an appendectomy.
C. A pregnant woman who has a fractured femur.
D. A client with diabetes who has a heart catheterization.
Correct Answer: D. A client with diabetes who has a heart catheterization
Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catheterization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. The development of Acute Kidney Injury (AKI) following cardiac catheterization or Percutaneous Coronary Interventions (PCI) is a serious complication. Around 10% to 15% of patients develop AKI after coronary interventions.
Option A: A dialysis client already has end-stage renal disease and wouldn’t develop acute renal failure. As the kidneys failed, the level of creatinine in the blood rose. The amount of creatinine in the blood is a factor used in calculating the GFR (glomerular filtration rate, a measure of kidney function). As creatinine goes up, GFR goes down.
Option B: A teenager who has an appendectomy isn’t at risk for renal failure. Postoperative abscesses, hematomas, and wound complications are all complications that can be seen after appendectomies. If the wound does get infected, one may grow Bacteroides. “Recurrent” appendicitis can occur if too much of the appendiceal stump is left after an appendectomy. This acts just like an appendix and can become occluded and infected just as with the initial episode.
Option C: A pregnant woman with a fractured femur isn’t at increased risk for renal failure. Orthopedic injury in pregnancy, though rare, is associated with significant morbidity and mortality to the mother and fetus. Some reports estimate that the risk of intrauterine fetal demise (IUFD) is as high as 40.1%, depending on the location of the fracture.
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