A 64-year-old man with chronic kidney disease (baseline creatinine 2.5 mg/dL) is started on lisinopril for hypertension. Two weeks later, his serum creatinine rises to 3.8 mg/dL. Urinalysis is bland. Renal artery ultrasound with Doppler shows peak systolic velocities suggestive of >70% stenosis bilaterally. Which of the following is the most likely diagnosis?
- A)Progression of underlying chronic kidney disease
- B)Acute tubular necrosis from hypotension
- C)Acute interstitial nephritis from lisinopril
- D)Acute glomerulonephritis
- E)Acute kidney injury from ACE inhibitor in bilateral renal artery stenosisGABARITO
Explicação
ACE inhibitors/ARBs are contraindicated in bilateral RAS because they efferent arteriolar vasodilation is necessary to maintain glomerular filtration pressure when afferent flow is compromised. Removing this hemodynamic compensation causes acute GFR decline. T... Ver explicação completa e trilha adaptativa →