Intrinsic acute kidney injury (non-glomerular causes) Quiz: Ace Your Exams
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A 61-year-old man presents with one month of worsening back pain in the lumbar and thoracic spine. He reports the pain is partially relieved with acetaminophen but aggravated with activity. Most days, he takes 1-2 ibuprofen twice a day for pain relief. Past medical history includes hypertension, type 2 diabetes mellitus, and osteopenia. He takes daily calcium and vitamin D supplementation, along with metformin and lisinopril. Physical examination and laboratory studies were normal during his annual visit 4 months ago. Vital signs at today’s visit show a temperature of 36.6°C (97.8°F), blood pressure of 148/82 mm Hg, pulse of 94/min, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. The patient appears well, with no lymphadenopathy, and normal cardiopulmonary, abdominal, and musculoskeletal examinations. Muscle strength is 5/5 in all extremities, and there is no reproducible spinal tenderness to palpation. Laboratory results are shown below. Which of the following is the most probable cause of this patient’s current condition?
| Laboratory value | Result |
| Hemoglobin | 10.9 g/dL |
| Platelets | 210,000/mm3 |
| Leukocytes | 13,000/mm3 |
| Creatinine | 2.2 mg/dL (previously 0.8 mg/dL) |
| Blood urea nitrogen | 45 mg/dL |
| Calcium | 10.8 mg/dL |
| Urinalysis | 2+ protein, 1+ blood, few granular casts, light chains |
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