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

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A 48-year-old woman presents to the clinic with fatigue, fever, arthralgias, and a diffuse rash that developed over the past three days. She reports decreased urine output. Past medical history includes hypertension, for which she takes amlodipine. She has no history of kidney or autoimmune disease. Temperature is 38°C (100.4°F), blood pressure is 135/85 mmHg, heart rate is 98 beats per minute, respiratory rate is 14 breaths per minute, and oxygen saturation is 98% on room air. There is a diffuse, non-pruritic maculopapular rash over the trunk and extremities. There is no jugular venous distention or peripheral edema. Cardiopulmonary examination is unremarkable. There is no joint swelling. Laboratory results are obtained and shown below. A renal ultrasound shows normal kidney size and echogenicity without evidence of hydronephrosis. Which of the following is most likely caused this patient’s current condition? 

 Laboratory value      Result     Reference range    
 Leukocytes     13,000/mm3     4,500-11,000/mm3    
 Neutrophils     60%     54-62%    
 Lymphocytes     24%     25-33%    
 Eosinophils     15%     1-3%    
 Creatinine     3.2 mg/dL (baseline 0.8 mg/dL)     0.6-1.2 mg/dL    
 Blood urea nitrogen     45 mg/dL     7-18 mg/dL    
 Urinalysis     2+ protein, 1+ blood, 10-15 white blood cells per high power field, no bacteria, white blood cell casts     No protein, blood, white blood cells, bacteria, or casts    

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