A 64-year-old man with chronic kidney disease (baseline creatinine 2.1 mg/dL, CrCl 25 mL/min) presents to the hospital with fever (38.9°C), hypotension (88/54 mmHg), and tachycardia (118 bpm). Blood cultures grow Escherichia coli. He is treated with gentamicin 5 mg/kg IV as a single daily dose. On hospital day 5, his serum creatinine rises to 3.8 mg/dL. Urinalysis shows muddy brown casts and fine granular casts. The fractional excretion of sodium is 3.2%. Urine output remains 1.2 mL/kg/hr. Which of the following best explains the mechanism of this patient's acute kidney injury?
- A)Prerenal azotemia from sepsis-induced reduction in renal perfusion pressure
- B)Acute interstitial nephritis from drug hypersensitivity reaction
- C)Accumulation of aminoglycoside in proximal tubule cells causing acute tubular necrosisGABARITO
- D)Post-infectious glomerulonephritis with immune complex deposition
- E)Rhabdomyolysis-induced myoglobinuria and tubular obstruction
Explicação
The clinical presentation is consistent with aminoglycoside-induced acute tubular necrosis (ATN). Key findings include: (1) administration of a high-dose gentamicin (5 mg/kg once daily) in a patient with severe renal impairment (CrCl 25 mL/min), (2) acute rise... Ver explicação completa e trilha adaptativa →