When mismatched blood is transfused, the major causes of renal shutdown are :

I. Renal vasoconstriction

II. Hyper bilirubinemia

III. Circulatory shock

IV. Thrombus formation

V. Renal tubular blockage

1. A

   I, II, V

2. B

   I, III, V

3. C

   I, II, IV, V

4. D

   I, IV, V

Appeared in: NIA - 29 January 2023

Explanation

• A mismatched blood transfusion triggers an acute hemolytic reaction, leading to renal shutdown through three primary mechanisms.
• The immune response releases vasoactive substances causing intense renal vasoconstriction, which reduces blood flow to the kidneys.
• Systemic inflammation leads to hypotension and circulatory shock, resulting in poor renal perfusion and ischemic injury.
• Massive hemolysis releases free hemoglobin, which precipitates in the renal tubules, causing physical obstruction and acute tubular necrosis.

Why Other Options Were Wrong

• Option A: This option incorrectly includes Hyperbilirubinemia (II). Hyperbilirubinemia, which causes jaundice, is a consequence of red blood cell breakdown, not a direct cause of renal failure.
• Option C: This option is incorrect because it includes both Hyperbilirubinemia (II) and Thrombus formation (IV). Hyperbilirubinemia is a consequence, and while thrombus formation (DIC) can occur, it's not considered as primary a cause as shock and vasoconstriction.
• Option D: This option incorrectly includes Thrombus formation (IV) and omits Circulatory shock (III). While Disseminated Intravascular Coagulation (DIC) can contribute, circulatory shock is a more direct and major cause of reduced kidney perfusion.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pathophysiology of acute kidney injury following an acute hemolytic transfusion reaction (AHTR) in acute care settings.
• Recognizing the signs of an acute hemolytic transfusion reaction (fever, chills, back pain, hypotension, red urine) is a critical nursing responsibility.
• The first and most important nursing intervention is to immediately stop the transfusion and keep the IV line open with a new bag and tubing of normal saline.
• Prompt notification of the physician and blood bank, along with close monitoring of vital signs and urine output, is essential to manage complications like renal failure and shock.

How to Approach the Question

• First, identify the core clinical event: a mismatched blood transfusion.
• Recall the immediate consequence: an acute hemolytic transfusion reaction (AHTR).
• Focus on the specific complication asked about: renal shutdown (acute kidney injury).
• Analyze the pathophysiological links between AHTR and the kidneys. Think about blood flow, blood pressure, and what happens to the byproducts of hemolysis.
• Evaluate each of the five listed items. Classify each as a direct cause, a consequence (result), or a secondary complication.
• Select the option that correctly groups the major, direct causes of renal failure in this scenario.

Concept Tested & Keywords

• Concept Tested: Pathophysiology of acute kidney injury following an acute hemolytic transfusion reaction (AHTR).
• Stem keywords: mismatched blood, transfusion, renal shutdown
• Lead-in keywords: major causes
• Negative lead-in flag: false

Question ID

QUPKoDznjfGzcql7kfjn2m

Copy ID

Reference Book

E6 Physiology Essentials Sembulingam 10e Part 1 p. 149-151

E6 Gynecology Williams p. 8-29