 Welcome back to our meds smarter question of the week where we're taking a smarter approach to preparing future physicians Before we get started if you'll take just a quick minute and click that like button and also Subscribe and turn the bell on so that you'll be notified when we post new videos. Let's get into a reno question today As always we start with the last Sentence of the vignette before we read the rest so that we know what this is asking us Which of the following is the most appropriate treatment a 43-year-old man is hospitalized with hypovolemic shock after massive blood loss in a motor vehicle accident on the patient's second day In the hospital his blood urea nitrogen or BUN and creatinine levels begin to rise and he develops pitting edema up to his knees a subsequent year analysis shows numerous granular casts So which of the following is the most appropriate treatment? So the most important thing to note in this question is that a patient had hypovolemic shock because of massive blood loss So when you have massive blood loss, we have less Blood and nutrients and oxygen that's able to get to some of the tissues So when we see blood urea nitrogen and creatinine levels begin to rise and Then we see these numerous granular cast show up on their year analysis That tells me this patient's undergoing what's known as acute tubular necrosis So what we're needing to know now is what is the best treatment or the most appropriate treatment for a patient? That is currently undergoing acute tubular necrosis. So let's look at those answer choices broad-spectrum antibiotics a B corticosteroids C fluids and dialysis D angioplasty or E use of ultrasound to remove blockage Take a minute read through the question and answer choices again Come up with your answer and put it in the comment box below Well first and foremost because we already have determined that this is acute tubular necrosis that can help us eliminate some of these Answer choices So I'm gonna go ahead and eliminate answer choice a because acute tubular necrosis isn't due to an infection This is actually due to Loss of blood and hypovolemia. So there's no infection. We need to clear up I would also note that if we do give them antibiotics a lot of times those antibiotics require renal clearance. So using Medications like this could cause more problems for those that are metabolized by the kidney I'm gonna leave B in for the time being I'm gonna leave C in for the time being D angioplasty, we don't need to go in and revascularize any of the arteries in the kidneys because that's not what our problem is So D is gonna be a choice eliminated and then E use of ultrasound to remove blockage We've already determined acute tubular necrosis that doesn't have a blockage. So we're going to eliminate that choice as well So that leaves us down to choice B and choice C and we're asking for what the most appropriate treatment is Well, I know corticosteroids can be used for Acute renal failure, but that's really more going to be associated with immune mediated disease rather than Hypovolemic problems. We wouldn't use corticosteroids in this instance because that's a different type of renal failure So in that case my choice is going to be answer choice C fluids and dialysis and C is the correct answer So like we said, this patient is dealing with acute tubular necrosis or ATN This is because of that ischemia that happened during that motor vehicle accident and the massive blood loss The problem here that we're having is acute tubular necrosis of our specifically of our epithelial cells in the proximal convoluted tubule a key buzzword for us to Thank acute tubular necrosis is going to be those Numerous granular cast those numerous granular cast are a good sign that we are dealing with acute tubular necrosis So what we're going to do with this patient is to correct that fluid Loss and try and bring back the fluid balance and the electrolyte balance into the body so reflux placement should be started and it should use crystalloid like normal saline or lactated ringers as Well as some of our blood products because we had lost so much blood we do need to replace some of those blood products as well and then if We don't see much recovery of our renal function immediately Then we will definitely move on into dialysis. So fluids and dialysis is typically going to be indicated in these patients Until the kidneys could recover if they do recover This could be something that could take a few weeks Hopefully and not something permanent, but there is a chance that this could cause some permanent damage If you found this material helpful for your studying Please like and consider subscribing to the channel also share this video so that more people can benefit from it like you have