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The following patient has been admitted to ICU with suspected renal injury. Base

ID: 3520159 • Letter: T

Question

The following patient has been admitted to ICU with suspected renal injury. Based on the results in the table below, which of the following conditions does patient 4 probably have?

Parameter

Normal range

Patient 4

Plasma

Albumin

35-50 g/L

48

Urea (BUN)

2.5-7.1 mM

18.2

Creatinine

61-107 uM

331

Potassium

3.5-5.0 mM

5.1

pH

7.35-7.45

7.32

osmolality

275-299 mOsMol/kg

318

Urine

Protein

Negative

Negative

Glucose

Negative

Negative

Osmolality

50-1200 (>500 if excretion rate lower than normal)

402

Urine: plasma osmolality ratio

>1.3

1.28

Urine sodium

<10 mM

11.1

Fractional clearance sodium

1%

1.21

Urine output

>0.5 ml/kg per hour

0.1 ml

a.

Risk of renal injury

b.

Pre-renal injury

c.

Intra-renal injury

d.

Intra-renal failure

e.

Pre-renal failure

Explanation / Answer

As there are no proteins in the urine and the amount of urine is decreased due to decreased GFR which has resulted from obstruction of blood filteration, this patient has pre-renal failure.