Renal failure Quiz: Ace Your Exams
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A 40-year-old man presents to the emergency department with difficulty breathing over the past two days. His past medical history is significant for chronic liver disease secondary to chronic alcohol use disorder. His temperature is 36.6°C (97.8° F), pulse is 80/min, respirations are 21/min, and blood pressure is 125/80 mm Hg. Physical examination shows abdominal distention with shifting dullness. Serum creatinine concentration is 1.5 mg/dL, and serum urea nitrogen concentration is 20 mg/dL. The patient is started on furosemide, and his condition quickly improves. Three days later, repeated laboratory studies show the following:
Which of the following is the most likely explanation for these laboratory findings?
| Laboratory value | Result |
| Serum | |
| Sodium | 132 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 95 mEq/L |
| Creatinine | 1.9 mg/dL |
| Albumin | 3.2 g/dL |
| BUN/Cr | > 20 |
| Urine | |
| Erythrocytes | 0/hpf |
| Leukocytes | 2/hpf |
| Fractional excretion of sodium (FENa) | <1% |
| Urine osmolality | 600 mOsm/kg |
| Sediment | None |
Which of the following is the most likely explanation for these laboratory findings?
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