Intrinsic acute kidney injury (glomerular causes) Quiz: Ace Your Exams
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A 50-year-old man presents to the emergency department with worsening shortness of breath, hemoptysis, dark-colored urine, and leg swelling over the past week. Two weeks ago, the patient experienced a “flu-like illness.” There is no chest pain or history of kidney disease. The patient has unintentionally gained 5 pounds in the past few days. Past medical history includes well-controlled hypertension managed with lisinopril. Temperature is 38°C (100.4°F), blood pressure is 154/80 mmHg, heart rate is 102/minute, respiratory rate is 16/minute, and oxygen saturation is 88% on room air. Lung auscultation reveals bilateral crackles. There is 2+ pitting edema in both lower extremities and periorbital swelling. Laboratory studies are shown below. Urinalysis reveals 3+ blood and 2+ protein with red blood cell (RBC) casts on microscopy. Chest X-ray shows bilateral alveolar infiltrates consistent with pulmonary edema or alveolar hemorrhage. Electrocardiogram (ECG) shows peaked T waves. Which of the following is the best next step in management?
| Laboratory Test | Result |
| Serum creatinine | 7.0 mg/dL (baseline 1.1 mg/dL 2 months ago) |
| Blood urea nitrogen (BUN) | 78 mg/dL |
| Potassium | 6.9 mEq/L |
| Bicarbonate | 12 mEq/L |
| pH (venous blood gas) | 7.20 |
| Anion gap | 22 |
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