Intrinsic acute kidney injury (glomerular causes) Quiz: Ace Your Exams
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A 35-year-old woman presents to the emergency department with worsening shortness of breath, hemoptysis, and decreased urine output over the past week. There is associated fatigue and unintentional weight loss, but no fever, recent travel, or known exposure to infectious agents. Temperature is 98.6°F (37°C), blood pressure is 160/95 mmHg, heart rate is 98/min, respiratory rate is 26/min, and oxygen saturation is 90% on room air. Lung auscultation reveals bilateral crackles, and there is 1+ pitting edema of the lower extremities. Laboratory results are shown below. A chest X-ray demonstrates diffuse alveolar infiltrates consistent with pulmonary hemorrhage. The patient is started on emergent hemodialysis and high-dose intravenous (IV) glucocorticoids. 24 hours later, renal function continues to worsen. Which of the following is the best next step in management?
| Laboratory Test | Result |
| Serum creatinine | 5.8 mg/dL (baseline 0.7 mg/dL) |
| Blood urea nitrogen (BUN) | 72 mg/dL |
| Potassium | 6.4 mEq/L |
| Bicarbonate | 14 mEq/L |
| pH (arterial blood gas) | 7.26 |
| Complement C3 | Normal |
| Complement C4 | Normal |
| Anti-glomerular basement membrane antibodies (anti-GBM) | Positive |
| ANCA | Negative |
| Urinalysis | 3+ blood, 2+ protein, RBC casts |
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