Intrinsic acute kidney injury (non-glomerular causes) Quiz: Ace Your Exams
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A 32-year-old man presents to the emergency department with severe muscle pain, weakness, dark tea-colored urine, and decreased urine output after completing a marathon yesterday. He reports running in extremely hot and humid conditions. He does not have chest pain, shortness of breath, or a recent infection. Temperature is 37°C (98.6°F), blood pressure is 96/64 mmHg, heart rate is 98 beats per minute, respiratory rate is 14 breaths per minute, and oxygen saturation is 98% on room air. The patient’s mucous membranes appear dry, and there is tenderness in the muscles of the calves and thighs bilaterally. There is also bilateral lower extremity swelling. No bruising is noted. Cardiopulmonary examination is normal. Neurologic examination reveals normal reflexes and intact sensation. Laboratory results are shown below. Which of the following is the most appropriate next step in management?
| Laboratory value | Result |
| Creatinine | 4.2 mg/dL (baseline 1.0 mg/dL) |
| Blood urea nitrogen | 55 mg/dL |
| Potassium | 5.3 mEq/L |
| Creatine kinase | 50,000 U/L |
| Urinalysis | 1+ protein, no red blood cells, dark colored urine |
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