A 64-year-old woman admitted for acute pancreatitis develops acute kidney injury on hospital day 3. Urinalysis shows muddy brown casts and tubular epithelial cells. Creatinine is 3.1 mg/dL (baseline 0.9), urine osmolality is 350 mOsm/kg, and fractional excretion of sodium is 2.8%. Which of the following is the most likely pathophysiology?
- A)Prerenal azotemia from decreased effective circulating volume
- B)Acute interstitial nephritis from prophylactic antibiotics
- C)Postrenal obstruction from pancreatic duct stricture
- D)Acute tubular necrosis from rhabdomyolysis and hypovolemiaGABARITO
- E)Acute glomerulonephritis from immune complex deposition
Explicação
Acute pancreatitis causes AKI through multiple mechanisms including hypovolemia (from third-spacing), rhabdomyolysis from tissue injury, and direct tubular toxins. The muddy brown casts (ATN hallmark), elevated FENa >2%, and tubular epithelial cells confirm in... Ver explicação completa e trilha adaptativa →