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Old 08-21-2012
tyagee's Avatar
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Default most likely cause of this renal failure..with reason !

A 65-year-old man with a history of stage 4 chronic kidney disease and hypertension comes
for a follow-up examination. Two days ago, he was discharged from the hospital after a 4-
day stay for pneumonia. During his hospitalization, his blood pressure averaged 130/70 mm
Hg and he was not exposed to radiocontrast agents. He was treated with ceftriaxone and
azithromycin; on discharge, these agents were discontinued and he began oral levofloxacin.
Since his discharge, he has had nausea, vomiting, and anorexia. He believes that his urine
output over the past day has been less than 500 mL. Additional medications are lisinopril,
calcium carbonate, and low-dose aspirin.
On physical examination, temperature is 35.8C (96.4F), blood pressure is 110/50 mm Hg
standing and 100/80 mm Hg supine, pulse rate is 108/min standing and 96/min supine, and
respiration rate is 16/min. The remainder of the examination is normal except for crackles
heard at the base of the lungs bilaterally.
Serum creatinine 6.0 mg/dL (530.4 μmol/L) (2.5 mg/dL [221.0 μmol/L] in the hospital)
Urinalysis Specific gravity 1.016; no protein or blood; occasional hyaline casts
Which of the following is the most likely cause of this patient's acute kidney
injury?
(A) Acute interstitial nephritis
(B) Acute tubular necrosis
(C) Prerenal azotemia
(D) Renal vein thrombosis
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Old 08-21-2012
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think C ..........pre renal azotemia as pt has ace inhibitors and aspirin ( inhibits prostaglandin induced dilation ) ......not sure though ......
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Old 08-21-2012
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Quote:
Originally Posted by Hitman View Post


think C ..........pre renal azotemia as pt has ace inhibitors and aspirin ( inhibits prostaglandin induced dilation ) ......not sure though ......
C, would also explain the orthostatic hypotension
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Old 08-21-2012
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Default C

Quote:
Originally Posted by tyagee View Post
A 65-year-old man with a history of stage 4 chronic kidney disease and hypertension comes
for a follow-up examination. Two days ago, he was discharged from the hospital after a 4-
day stay for pneumonia. During his hospitalization, his blood pressure averaged 130/70 mm
Hg and he was not exposed to radiocontrast agents. He was treated with ceftriaxone and
azithromycin; on discharge, these agents were discontinued and he began oral levofloxacin.
Since his discharge, he has had nausea, vomiting, and anorexia. He believes that his urine
output over the past day has been less than 500 mL. Additional medications are lisinopril,
calcium carbonate, and low-dose aspirin.
On physical examination, temperature is 35.8C (96.4F), blood pressure is 110/50 mm Hg
standing and 100/80 mm Hg supine, pulse rate is 108/min standing and 96/min supine, and
respiration rate is 16/min. The remainder of the examination is normal except for crackles
heard at the base of the lungs bilaterally.
Serum creatinine 6.0 mg/dL (530.4 μmol/L) (2.5 mg/dL [221.0 μmol/L] in the hospital)
Urinalysis Specific gravity 1.016; no protein or blood; occasional hyaline casts
Which of the following is the most likely cause of this patient's acute kidney
injury?
(A) Acute interstitial nephritis
(B) Acute tubular necrosis
(C) Prerenal azotemia
(D) Renal vein thrombosis
Would go with C as the pt. on ACEI and at the same time having vomiting put him at a risk of pre renal azotemia.
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Old 08-21-2012
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ans is prerenal azotemia. ,
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