Effect on Kidneys After a Massive Blood loss

A 35-year-old man is admitted with systolic blood pressure (BP) of 60 mm Hg and a heart rate (HR) of 150 bpm following a gunshot wound to the liver (CT scan shown in picture below).

Axial image of Computed tomography (CT) scan of abdomen at level of both kidneys shows dense nephrogram, which is attributed to decrease in renal perfusion

What is the effect on the kidneys?
(A) They tolerate satisfactorily ischemia of 3–4 hours duration.
(B) They undergo further ischemia if hypothermia is present.
(C) They can become damaged, even though urine output exceeds 1500 mL/d.
(D) They are affected and cause an increased creatinine clearance.
(E) They are prevented from further damage by a vasopressor.

Answer:
(C) They can become damaged, even though urine output exceeds 1500 mL/d.

Discussion: High-output renal failure should be suspected if the BUN continues to rise with urine
output >1000–1500 mL/d. It is associated with mild-to-moderate renal insufficiency; in comparison, severe renal injury results in oliguric renal failure. The kidneys do not tolerate ischemia for more than 30–90 minutes.
Hypothermia is protective.
There is a decrease in creatinine clearance.
Vasopressors aggravate the deleterious effects of shock.