Renal Replacement Therapy

Abstract

A 72-year-old man is brought to the emergency department from his skilled nursing facility for shortness of breath and altered mental status. He is admitted to the medical intensive care unit (ICU) with pneumonia and septic shock. He receives appropriate antibiotics, intravenous fluids, and vasopressor therapy. He requires intubation for failure to protect his airway. By hospital day 4, his shock has resolved but he remains on the ventilator. He develops acute on chronic renal failure owing to septic acute tubular necrosis. He is anuric and grossly volume overloaded. His past medical history includes coronary artery disease, congestive heart failure, type 2 diabetes mellitus, chronic kidney disease stage III, and dementia.