Questions for Discussion:

  1. What are the three broad categories that acute renal failure can be divided into?
  2. Utilizing the urine and blood chemistry values, how can one distinguish between prerenal azotemia and acute tubular necrosis?
  3. Based on the information provided, what is the most likely etiology of this patient’s renal failure?
  4. What additional tests would be helpful in confirming the diagnosis?
  5. a. What are the indications for dialysis in general?
    b. What are the indications for dialysis specifically in this patient?
  6. What EKG abnormalities are associated with hyperkalemia?
  7. How would you acutely manage the hyperkalemia in this patient?
  8. How would you interpret the renal ultrasound findings in this case?
  9. This patient has hyperkalemia, hypocalcemia and hyperphosphatemia.  What factor(s) are responsible for these derangements?