Skip to Main Content

Acute Kidney Injury

Chapter 25. Acute Kidney Injury

Student Questions

Her acute kidney injury is most likely due to which of the following?

A 69-year-old woman is admitted to the hospital with nausea and vomiting. Her blood pressure is 92/60 mm Hg, heart rate is 90 beats/min, and she demonstrates orthostatic hypotension. Her past medical history includes hypertension, hypothyroidism, and osteoarthritis. Her baseline SCr and BUN upon admission to the hospital were 1.5 mg/dL (133 μmol/L) and 24 mg/dL (8.6 mmol/L), respectively. Two days later, her SCr has increased to 3.1 mg/dL (274 μmol/L) and her BUN is 56 mg/dL (20.0 μmol/L). Her urine output was 900 mL over the past 24 hours.

Medications include: enalapril 10 mg orally per day, acetaminophen 650 mg orally every 4 to 6 hours as needed, and levothyroxine.

A. Hypertension

B. Pre-renal AKI secondary to vomiting

C. Intrinsic AKI secondary to hypothyroidism

D. Osteoarthritis

Answer: B

Option A: Incorrect. While hypertension can cause chronic kidney disease, it does not result in AKI.

Option B: Correct. Physical examination findings of low blood pressure, orthostatic hypotension, and history of nausea are consistent with pre-renal AKI due to reduced intravascular volume, which can be caused by vomiting. In addition, the BUN-to-creatinine ratio of 20 is also consistent with pre-renal AKI.

Option C: Incorrect. Hypothyroidism does not result in AKI.

Option D: Incorrect. Osteoarthritis does not cause AKI.

Which of the following would be appropriate pharmacotherapy to administer to this patient for AKI?

A 69-year-old woman is admitted to the hospital with nausea and vomiting. Her blood pressure is 92/60 mm Hg, heart rate is 90 beats/min, and she demonstrates orthostatic hypotension. Her past medical history includes hypertension, hypothyroidism, and osteoarthritis. Her baseline SCr and BUN upon admission to the hospital were 1.5 mg/dL (133 μmol/L) and 24 mg/dL (8.6 mmol/L), respectively. Two days later, her SCr has increased to 3.1 mg/dL (274 μmol/L) and her BUN is 56 mg/dL (20.0 μmol/L). Her urine output was 900 mL over the past 24 hours.

Medications include: enalapril 10 mg orally per day, acetaminophen 650 mg orally every 4 to 6 hours as needed, and levothyroxine.

A. 0.9% normal saline IV

B. Albumin 25% IV

C. Furosemide 80 mg IV

D. Hydrochlorothiazide 25 mg PO

Answer: A

Option A: ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.