A 19-year-old develops acute kidney injury (AKI) following a road traffic accident (RTA). Which of the follow… - AIIMS M.Sc. Nsg Entrance exam-2026

AIIMS M.Sc. Nsg Entrance exam-2026

Medical Surgical Nursing

Hard

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

Prerenal AKI results from decreased renal perfusion (blood flow to the kidneys).
A road traffic accident (RTA) is a common cause of major trauma and hemorrhage (significant blood loss).
Hemorrhage leads to hypovolemia (low circulating blood volume) and hypotension (low blood pressure).
This systemic hypoperfusion reduces blood flow to the kidneys, decreasing the glomerular filtration rate (GFR) and causing acute kidney injury.
Therefore, in the context of an RTA, a prerenal cause is the most probable initial reason for AKI.

Option A: Postrenal AKI is caused by an obstruction of the urinary tract (e.g., in the ureters, bladder, or urethra). While trauma can cause such an obstruction (e.g., a pelvic fracture damaging the bladder), it is a less common immediate cause of AKI following an RTA compared to hypovolemia.
Option B: Intrarenal (or intrinsic) AKI involves direct damage to the kidney structures (glomeruli, tubules). While this can occur in trauma, it is often a secondary event. The most common cause of intrarenal AKI in this setting is Acute Tubular Necrosis (ATN) resulting from prolonged ischemia, which starts as a prerenal problem.
Option D: Intrinsic renal is a synonym for intrarenal AKI. The reasoning for it being an incorrect choice is the same: the most likely initial cause of AKI in a trauma patient with significant blood loss is the prerenal state of hypoperfusion, not direct kidney tissue damage.

Visual 1: Flowchart. A flowchart illustrating the sequence: Road Traffic Accident → Massive Hemorrhage → Hypovolemia/Hypotension → Decreased Renal Perfusion → Prerenal AKI.
Visual 2: Diagram. A simple diagram showing the three categories of AKI causes: Prerenal (problem with blood flow to the kidney), Intrarenal (problem within the kidney), and Postrenal (problem with urine flow out of the kidney).

Clinical Relevance

Nursing practice connection: Knowing Pathophysiology of Acute Kidney Injury (AKI) in trauma helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
In trauma care, a nurse's primary role includes rapid assessment for signs of hypovolemic shock (e.g., tachycardia, hypotension, pale/cool skin, decreased urine output) to prevent organ damage, including AKI.
Prompt fluid resuscitation with intravenous fluids and blood products is critical to restore renal perfusion and prevent the progression from reversible prerenal AKI to irreversible intrarenal damage (ATN).
What if the patient was a crush injury victim trapped for 8 hours before rescue? In that scenario, the most likely cause would shift to intrarenal AKI. The prolonged muscle compression would cause rhabdomyolysis, releasing large amounts of myoglobin, which is directly toxic to the renal tubules, causing ATN.

How to Approach the Question

First, identify the key elements of the clinical scenario: a young patient, a traumatic event (RTA), and the resulting condition (AKI).
Next, consider the most common and immediate life-threatening complication associated with an RTA, which is significant hemorrhage leading to hypovolemic shock.
Connect this primary complication to kidney function. Hypovolemia means less blood volume, which directly leads to reduced blood flow (perfusion) to the kidneys.
Recall the classifications of AKI. A problem caused by decreased blood flow to the kidney is defined as a 'prerenal' cause.
Evaluate the other options. Intrarenal (damage inside the kidney) and postrenal (obstruction after the kidney) are possible in trauma, but prerenal failure due to blood loss is the most frequent and immediate cause.
Therefore, conclude that prerenal is the most likely cause in this scenario.

Concept Tested & Keywords

Concept Tested: Pathophysiology of Acute Kidney Injury (AKI) in trauma.
Stem keywords: acute kidney injury (AKI), road traffic accident (RTA), 19-year-old
Lead-in keywords: most likely cause
Clinical cues: The clinical cue "road traffic accident (RTA)" strongly suggests the potential for major hemorrhage and subsequent hypovolemic shock, which is a primary cause of prerenal AKI.

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