A patient is experiencing prerenal failure secondary to hypovolemia

Question

The nurse reviewing the patient's laboratory work and vascular pressures would expect to see which results? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Creatinine clearance of 50 mL/min/1.73m2
2. Low CVP or PAWP pressures
3. BUN of 65 mg/dL
4. Serum creatinine of 3 mg/dL
5. Urine with granular casts and sediment

Answer 1

1,2,3,4
Rationale 1: Creatinine clearance provides the most accurate estimate of glomerulo-filtration rate. Normal values range between 85 and 125 mL/min/1.73m2 for adult men and 75 to 115 mL/min/1.73m2 for adult women. Values below normal indicate at least a 50% reduction in the number of functioning nephrons.
Rationale 2: With prerenal dysfunction, the nurse assesses the patient for manifestations of hypovolemia, including low CVP or PAWP values.
Rationale 3: When the urine flow rate is reduced, more urea is absorbed. Thus, in prerenal failure, the rise in BUN may be out of proportion to the renal dysfunction.
Rationale 4: A doubling of serum creatinine normally indicates a 50% reduction in glomerular filtration rates. Normal levels in adults are 0.5 to 1.5 mg/dL.
Rationale 5: There are rarely more then a few casts and/or a little sediment present in the urine. The urine appears dark and concentrated but it is clear.