An overview of renal failure &
considerations for treatment
By Robert P. Girardeau, MSM-HCA, NRP, FP-C
Among critically ill and injured patients, maintaining homeosta- sis and preserving adequate organ
function is always the primary objective of
our care. However, the sequela of our most
frequently encountered disease processes can
greatly impact this goal.
When derangements in homeostasis prog-
ress to organ dysfunction, patients can quickly
become critically ill, with steadily increasing
mortality rates. One of the first systems to
derail because of critical illness are the kidneys.
When renal dysfunction occurs as a result of an
acute illness, an experienced, multidisciplinary
team may be needed to effectively care for
In many instances, these patients require
very specialized critical care teams and
advanced renal replacement therapies (RR Ts)
that can only be offered by tertiary and quaternary care centers. Most patients don’t initially seek medical attention from one of these
large, academic centers usually located in urban
areas. The initial stages of these patients’ care
are provided at outlying community hospitals.
The patients’ illnesses have either progressed to a point where they’ve exhausted
the resources and expertise available at the
community hospital, or the patient was initially
stabilized and prepared for transfer to one of
these major centers at a later time.
Regardless of the path taken, EMTs and
paramedics will be called to bring their expertise to the table and assist in moving these
critically ill and complex patients from one
hospital to another. In this article, we’ll discuss the causes of acute kidney injury (AKI),
its clinical features, progression and indications
for advanced therapies.
>> Demonstrate an in-depth knowledge of acute kidney injury (AKI) and how it applies to the
practice of prehospital emergency medicine and critical care transport medicine.
>> Compare and contrast the three categorical causes of AKI: pre-renal, intra-renal and post-renal.
>> Compose a care plan for a critically ill patient with an AKI who’s in need of interfacility transport for continuous renal replacement therapy, accounting for a patient’s hemodynamic status,
fluid status, electrolyte derangements, baseline/current renal functioning, trends in cardiovascular/
pulmonary status and treatment outcomes up to this point.