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Acute renal failure: Ms. Jones, a 68-year-old female, underwent open-heart surgery to replace several blocked vessels in her heart. On her first day postoperatively, it was noted that she had very
little urine output. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom?
Acute renal failure: Mrs Jones is suffering an acute kidney injury due to hypo perfusion likely linked to blood loss and/or low blood pressure during the operation. Reduced blood supply has caused the kidneys to cease to operate effectively. [ Her blood results will show elevated urea and creatinine while urine output will reduce to under 20mls/per hour. The solution is to rehydrate with IV
fluids and monitor vital signs regularly. She may need dialysis in the short term if her potassium increases or eGFR becomes very low. Prognosis will depend on extent of damage however there is every possibility that fluid resuscitation will restore normal function with time. Chronic kidney failure: this causes a gradual reduction in kidney function over time. Leading to fluid retention, ankle edema, reduced red cell production (thus leading to anemia) and then with congestive heart failure there is potential for fluid to collect in the lungs, causing shortness of breath and changes in blood vessels around the liver leading to liver failure and esophageal varices. The use of diuretics to treat the chronic heart failure also puts additional pressure on the kidneys. Prognosis is poor. ]
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