Patho Patho #47


The nurse is caring for a client with congestive heart failure. The client is hypotensive and tachycardic. Which type of acute kidney injury is this client at risk for developing?


  1. Pre-renal
    • Rationale:

      This answer choice is correct because hypotension results in inadequate cardiac output. When cardiac output is not sufficient, renal perfusion decreases. When acute kidney injury is attributed to inadequate perfusion, the cause is classified as pre-renal.

  2. Intra-renal
    • Rationale:

      This answer choice is not correct because an intra-renal cause would occur within the kidneys themselves such as ingestion of a nephrotoxic drug or contrast dye.

  3. Acute tubular necrosis
    • Rationale:

      This answer choice is not correct as acute tubular necrosis may be attributed to an intra-renal etiology for acute kidney injury.

  4. Post-renal
    • Rationale:

      This answer choice is not correct because a post-renal etiology for acute kidney injury occurs distal to the kidneys such as an obstruction in the ureters that blocks the outflow of urine from the bladder.


The focus of this question is asking the nurse to determine the type of acute renal injury a client is at risk for developing based on symptoms of congestive heart failure. Because the client is hypotensive, cardiac output is not adequate to perfuse the kidneys. When inadequate perfusion is the cause for renal injury, the etiology is classified as pre-renal.


Learning Outcomes

Etiologies for acute renal injury are broken down into three main classifications: pre-renal, intrarenal, and post-renal. Pre-renal causes may be attributed to issues with perfusion of the kidneys. Intrarenal causes are attributed to an insult that occurs within the kidneys themselves, such as a nephrotoxic drug. Post-renal causes are attributed to causes that obstruct the outflow of urine from the kidneys. Hypotension due to congestive heart failure is therefore classified as a prerenal etiology for acute kidney injury.

Test Taking Tip

When studying the classifications for etiologies of acute kidney injury, learn only the most common causes within each classification. For example, hypotension/ congestive heart failure is the most common cause of pre-renal acute kidney injury.

Video Rationale