A 72-year-old woman admitted with community-acquired pneumonia receives gentamicin therapy. On hospital day 3, she develops oliguria with urine output of 800 mL/day. Vital signs show BP 128/76 mmHg, HR 92/min, RR 20/min, temperature 37.2°C, and SpO2 98% on room air. Serum creatinine rises from 0.9 to 2.1 mg/dL. Urinalysis reveals muddy brown granular casts and tubular epithelial cells. FENa is 3.2%. Urine osmolality is 450 mOsm/kg. Which of the following is the most likely diagnosis?
- A)Aminoglycoside-induced acute tubular necrosisGABARITO
- B)Prerenal acute kidney injury
- C)Contrast-induced nephropathy
- D)Allergic glomerulonephritis
- E)Acute interstitial nephritis from gentamicin
Explicação
Aminoglycoside nephrotoxicity causes ATN through accumulation in proximal tubule cells. Elevated FENa (>2%) confirms tubular dysfunction. Granular and tubular cell casts are hallmark findings. The timeline (3 days post-exposure) and preserved urine output fit ... Ver explicação completa e trilha adaptativa →