WBR0404
| Author | [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathophysiology |
| Sub Category | SubCategory::Renal |
| Prompt | [[Prompt::A 56-year-old male presents to the ER with a high fever. The patient’s urine output is significantly decreased and work-up reveals the values illustrated in the following table. Based on the values below, which of the following is the most likely cause of the patient’s oliguria?
|
| Answer A | AnswerA::Acute interstitial nephritis |
| Answer A Explanation | [[AnswerAExp::Acute interstitial nephritis, a type of renal injury, would not manifest with high BUN/Creatinine ratio. In contrast, renal etiologies of acute kidney injury would have a serum BUN/Creatinine ratio < 15 with urine osmolarity commonly < 350 mOsm/kg.]] |
| Answer B | AnswerB::Bilateral renal cortical necrosis |
| Answer B Explanation | [[AnswerBExp::Diffuse bilateral renal cortical necrosis, a type of intrinsic renal injury, would not typically manifest with the lab values illustrated in the table. Diffuse bilateral renal cortical necrosis is usually an obstetric complication, which can also occur following trauma or sepsis.]] |
| Answer C | AnswerC::Renal stone complicated with hydronephrosis |
| Answer C Explanation | [[AnswerCExp::Renal stone complicated by hydronephrosis, a type of post-renal acute kidney injury, would generally manfest with elevated urinary sodium > 40 mEq/L.]] |
| Answer D | AnswerD::Urinary tract infection complicated by acute pyelonephritis |
| Answer D Explanation | [[AnswerDExp::WBC casts are characteristic of pyelonephritis. Because WBC casts are absent in this patient, the diagnosis of acute pyelonephritis is unlikely. In addition, acute pyelonephritis would not manifest with an elevated serum BUN/Creatinine ratio as demonstrated in this patient.]] |
| Answer E | AnswerE::Severe hypotension |
| Answer E Explanation | [[AnswerEExp::Hypotension may result in pre-renal acute kidney injury. Pre-renal azotemia is characterized by a serum BUN/Creatinine ratio > 20, Urinary osmolarity > 500 mOsm/kg, and urinary sodium < 20 mEq/L.]] |
| Right Answer | RightAnswer::E |
| Explanation | [[Explanation::The patient’s presentation and lab values are characteristic of a pre-renal azotemia. Severe hypotension can result in pre-renal azotemia. Calculating the BUN/Creatinine ratio is aids in the distinction between different types of acute kidney injury.
BUN/Creatinine = 80 / 2.5 = 32. Since the ratio is greater than 20, accompanied by elevated urine osmolarity > 500 mOsm/kg and urinary sodium < 20 mEq/L, the diagnosis of pre-renal azotemia is more likely than other renal or post-renal etiologies. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::kidney, WBRKeyword::excretory system, WBRKeyword::urine, WBRKeyword::renal, WBRKeyword::pre-renal azotemia, WBRKeyword::urinary sodium, WBRKeyword::renal injury, WBRKeyword::hypotension |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
