Approach to acute kidney injury Quiz: Ace Your Exams
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A 45-year-old woman presents to clinic with one week of fatigue, nausea, and a diffuse pruritic rash. She has no fever, chills, hematuria, dysuria, or significant changes in urinary frequency. Past medical history includes seasonal allergies and hypertension. She was recently prescribed amoxicillin for a sinus infection, which she started 10 days ago. She takes lisinopril for hypertension and loratadine as needed for allergies. She had not recently used non-steroidal anti-inflammatory drugs (NSAIDs), traveled, or been exposed to nephrotoxins. Temperature is 37.1°C (98.8°F), blood pressure is 130/82 mmHg, heart rate is 84 beats per minute, and respiratory rate is 14 breaths per minute. A diffuse, erythematous, maculopapular rash is noted over the trunk and arms. There is no edema, jugular venous distension, or costovertebral angle tenderness. Laboratory results are shown below. Renal ultrasound shows normal kidney size without hydronephrosis. Which of the following would be expected on urinalysis with microscopy?
| Laboratory test | Result |
| White blood cell count | 13,000 g/dL Differential: Neutrophils 68% Lymphocytes 24% Eosinophils 8% |
| Sodium | 138 mEq/L |
| Potassium | 4.3 mEq/L |
| Serum creatinine | 2.6 mg/dL (baseline 0.9 mg/dL 2 months ago) |
| Blood urea nitrogen (BUN) | 45 mg/dL |
| Urine culture | Negative |
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