A 64-year-old diabetic patient develops acute renal failure following an aortic aneurysm repair. Which of the following statement(s) is/are true concerning his diagnosis and management?

b. Maintenance of positive energy balance reduces protein catabolism and makes the management of renal failure easier

d. A nonoliguric renal failure is usually associated with a better outcome

In patients with nonoliguric renal failure, treatment may differ little from that required for identical patients with normal renal function. Management of fluids, solutes, and nutrition is usually unaffected by nonoliguric renal failure, although BUN may be elevated. The extent of renal dysfunction is limited and almost always reversible. The use of renal replacement therapies is rarely necessary. Acute renal failure can result in severe derangements in electrolyte and acid-based physiology. Of all electrolyte abnormalities that might occur, hyperkalemia is the most serious. Other electrolyte abnormalities such as hyponatremia, hyperphosphatemia, hypocalcemia, and metabolic acidosis are common and must be monitored carefully.

The metabolic requirements of a patient with acute renal failure are those of a critically ill hospitalized patient. The actual measurements of resting energy expenditure has shown that caloric requirements for multiorgan failure patients with renal failure are often 50% above normal, healthy individuals. Although acute renal failure may require fluid restriction, providing adequate nutrition is an important aspect of their treatment. Positive energy balance may make management of uremia and hyperkalemia less difficult. By providing adequate calories, endogenous protein catabolism with resultant generation of urea and release of potassium can be avoided. Maintenance of positive energy balance with glucose and lipids should reduce protein catabolism, urea generation, and hyperkalemia.