A child with 22-25 stool/day, 3 day old pneumonitis, no passage of urine from 36 hrs. low B.P., Blood PH - 7.21. Urine Na+ - 18 meq/L, S. Urea 120, serum Creatinine 1.2 indicate - (AIIMS Nov 2014)
|A||Acute cortical necrosis|
|B||Acute tubular necrosis|
|D||Acute medullary necrosis|
a. History and clinical features of the child suggests that he is suffering from acute renal failure-From the given values we have to get the cause of this renal failure.
b. H/o diarrhea with low Bp suggests dehydration - is cause of prerenal ARF.
Index Pre-renal Intrinisic renal
o Specific gravity or urine >1.20 <1.010
o Urine Osmolality >500m Osm <350 mOsm
o Urine Sodium >20m Eq/L <40 mEq/L
o FENa >1% <2%
(Fractional excretion of sodium)
o Blood urea nitrogen/creatinine >20 <20
c. BUN / creatinine = l20 / l.2 = 100 (suggestive of Pre-renal ARF).
d. Also, urine Na+ < 20 is a feature of pre-renal ARF.