Acute renal failure (Acute Kidney Injury part II)

• A 72 y.o. woman, is admitted to your hospital as an emergency with a two day history of abdominal pain of sudden onset. After resuscitation, she underwent laparotomy for a perforated sigmoid colon and peritonitis. Pre-operatively her urea was 15 mmol/l and creatinine 195 mmol/l. On the third day, her gas exchange deteriorated and despite an increase in cardiac output her perfusion pressure fell and she required an increase in the norepinephrine support. Renal function deteriorates with worsening oliguria despite restoring the circulation...
• A 25 y.o. man is admitted to hospital unconscious. He had started working on his car with the engine running in a closed garage. He had taken the precaution of leaving only a small quantity of fuel in the tank and the engine had stopped by the time he was found several hours later. On admission he was hypothermic (34.5ºC), shocked with a pulse rate of 140/min, BP 80/50 and a severe metabolic acidaemia (BE -20)...
• Mr C, aged 68, is brought to the emergency department unconscious, hypotensive and in respiratory distress. You have been called to see him to assist and just as you arrive he vomits, aspirates and has a respiratory arrest. As his resuscitation is proceeding more history is obtained revealing nocturia (3-4 times per night) and he is due to see the urologists...