Acute Kidney Injury Quiz Questions

NSAIDs (non-steroidal anti-inflammatory drugs) can cause renal dysfunction through various mechanisms. They can lead to pre renal azotemia by causing constriction of the renal blood vessels, reducing blood flow to the kidneys. NSAIDs can also cause acute tubular necrosis (ATN) by directly damaging the renal tubules. Additionally, they can contribute to acute kidney injury (AKI) by causing inflammation and oxidative stress in the kidneys. Furthermore, NSAIDs can worsen renal function in patients with nephrotic syndrome by further increasing proteinuria and impairing renal hemodynamics. Therefore, NSAIDs can cause renal dysfunction through all of the mentioned causes.

The most likely cause of AKI in this patient is Hepato renal syndrome. This is indicated by the patient's history of Hep C cirrhosis and EtOH abuse, as well as the progressive hypotension and oliguria. The elevated JVD and worsening ascites also suggest hepatic dysfunction. The increase in creatinine from baseline and low urine Na indicate renal dysfunction, which is commonly seen in Hepato renal syndrome. The negative initial cultures of ascitic fluid and blood suggest that infection is not the cause of the AKI. Drug-induced interstitial nephritis and ATN are less likely in this patient based on the clinical presentation and history. Pre-renal azotemia would typically be associated with hypovolemia, which is not described in this case.

Sulfonamides have been associated with both interstitial nephritis and crystal-induced nephropathy. Interstitial nephritis is an inflammation of the kidney tubules, often caused by an allergic reaction to medication. Crystal-induced nephropathy refers to the formation of crystals in the kidneys, which can lead to kidney damage. Sulfonamides are a class of antibiotics that have been known to cause these adverse effects on the kidneys.

The correct answer is renal tubular epithelial cell, RTE cell, RTE, tubular epithelial cell. Renal tubular epithelial cells are the cells that line the renal tubules in the kidneys. In the context of acute kidney injury (AKI), the presence of multiple renal tubular epithelial cells in the urine microscopy suggests damage to the renal tubules, which can occur as a result of various causes such as ischemia during coronary artery bypass graft (CABG) surgery. Therefore, the identification of renal tubular epithelial cells is consistent with the development of AKI in this patient.