A 58-year-old man undergoes elective abdominal aortic aneurysm repair. Postoperatively, he develops oliguria with BP 102/64 mmHg, HR 98/min, and serum creatinine 2.9 mg/dL (baseline 0.9 mg/dL). Urinalysis reveals muddy brown granular casts. Serum potassium is 5.8 mEq/L. Renal ultrasound shows no hydronephrosis or renal artery stenosis. Urine sodium is 58 mEq/L with FENa of 3.2%. Which of the following is the most likely etiology of his acute kidney injury?
- A)Cholesterol embolization from aortic manipulation
- B)Postoperative sepsis-related glomerulonephritis
- C)Contrast-induced nephropathy from preoperative angiography
- D)Prerenal azotemia from inadequate fluid resuscitation
- E)Ischemic acute tubular necrosis from aortic cross-clampingGABARITO
Explicação
Ischemic ATN occurs from renal artery occlusion during aortic cross-clamping, causing acute tubular injury. FENa >2% and high urine sodium indicate tubular dysfunction and loss of sodium reabsorption. Granular casts reflect necrotic tubular epithelium. Immedia... Ver explicação completa e trilha adaptativa →