Renal failure Quiz: Ace Your Exams

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A 58-year-old hospitalized man is currently hospitalized for repair of an abdominal aortic aneurysm. He successfully underwent surgery for the repair yesterday, but today he was noted to have decreased urine output during rounds. Past medical history includes type II diabetes mellitus and coronary artery disease. He received a prophylactic antibiotic prior to the procedure. The patient has been receiving 100ml/hour of normal saline since the surgery. His temperature is 37.0°C (98.6°F), pulse is 93/min, respirations are 20/min, and blood pressure is 115/75 mmHg. Physical examination shows non-erythematous wound with scant serous discharge and a soft abdomen. Urine output over the past six hours is measured at 90mL. Laboratory results from this patient’s hospitalization are demonstrated below.

 
 Laboratory value  Result 
 Serum chemistry 
  Day 1  Day 2 
 Sodium  135 mEq/L  132 mEq/L 
 Potassium  4.1 mEq/L  4.0 mEq/L 
 Chloride  98 mEq/L  97 mEq/L 
 Bicarbonate  25 mEq/L  23 mEq/L 
 Blood urea nitrogen (BUN)  16 mg/dL  36 mg/dL 
 Creatinine  1.1 mg/dL  2.3 mg/dL 
   
Urine sediment microscopy is shown.

An illustration shows 5 rod-shaped microorganisms, with textured surfaces, against a plain background inside a circular outline, resembling a petri dish.
Reproduced from: Wikipedia

Which of the following anatomic regions of the nephron was most likely affected given this patient's clinical presentation? 

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