OBJECTIVES

Discuss the physiologic role of the kidney in the regulation of fluid and electrolyte balance, arterial blood pressure, maintenance of acid-base homeostasis, and excretion of metabolic waste products. Given a case study of a patient in acute renal failure (ARF), identify the etiology (obstruction, prerenal azotemia, or acute tubular necrosis), interpret serum and urine laboratory abnormalities, and identify actual and potential systemic consequences of ARF. Discuss the relationship between the hemodynamic events in shock and acute renal failure. Define rhabdomyolysis and describe its clinical manifestations. Discuss the emergency management of the life-threatening complications of ARF, including: pulmonary edema, hyperkalemia, hypocalcemia / hyperphosphatemia, metabolic acidosis, and uremia. Compare and contrast renal replacement therapies: CAVH, CAVHD, hemodialysis, and peritoneal dialysis.