Question about Kidney failure

[Meow28]

Hello everyone,

 

I have a question for experienced individuals/medical professionals among you!

 

I am currently working in a monitoring station. My questions are often unanswered, and my research is usually insufficient.

So we often have patients with acute kidney failure and numerous heart conditions.

My question:

A patient presents with acute kidney failure, is cardiac decompensated, hypotensive to 70/40 mmHg, cardio-pulmonarily unstable. Furosemide does not promote excretion, and the patient is edematous. Of course, patients receive an artery for hemodynamic monitoring; the mean pressure is usually between 40-60.

We try to stabilize with Arterenol, but it's barely effective.

In this case, what would be your approach? Dialysis? Or is there an alternative therapy (medication or compression)?

Thank you for your tips and experiences.

 

[JBMmom, MSN, NP]

This patient would not be stable enough for any dialysis related treatment. The immediate concern would be the lack of perfusion which will kill the patient faster, and cause further kidney injury. Giving someone lasix with a pressure of 70/40 sounds like a very bad idea to me. Unless they're in respiratory failure due to the fluid overload.  Arterenol/norepinephrine is normally a first line but if it doesn't have enough inotropy to improve output you might want a straight inotrope.  I would consider epinephrine or dopamine.