Intrinsic acute kidney injury (non-glomerular causes) Quiz: Ace Your Exams

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A 68-year-old man presents to the clinic with worsening fatigue, leg pain, and purple discoloration of his toes for the past 2 days. He reports mild abdominal pain and notes dark urine. He recently had cardiac catheterization for the evaluation of chest pain. He has a history of hypertension, hyperlipidemia, and coronary artery disease, for which he takes aspirin, amlodipine, and atorvastatin. He has not had a fever, shortness of breath, or chest pain since the procedure. Temperature is 37°C (98.6°F), blood pressure is 145/90 mmHg, heart rate is 88 beats per minute, respiratory rate is 14 breaths per minute, and oxygen saturation is 98% on room air. Skin examination reveals reticular, lacy erythema that blanches with direct pressure on the chest and abdomen. Cardiopulmonary examination is unremarkable. Abdominal examination reveals mild diffuse tenderness without guarding or rebounding. Laboratory results are shown below. Which of the following is the best next step in management? 

 Laboratory value       Result     
 Hemoglobin      13.9 g/dL     
 Platelet      240,000/mm3     
 Leukocytes      14,500/mm3     
 Neutrophils      60%     
 Lymphocytes      24%     
 Eosinophils      15%     
 Creatinine      2.2 mg/dL (baseline 0.8 mg/dL)     
 Blood urea nitrogen      45 mg/dL     
 Sodium      138 mEq/L     
 Potassium      4.8 mEq/L     
 Urinalysis      1+ red blood cells, 1+ white blood cells, 1+ protein, no casts     

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