A 67-year-old man with diffuse atherosclerosis and poorly controlled hypertension despite amlodipine, hydrochlorothiazide, and metoprolol presents with acute dyspnea and fatigue. Vital signs: BP 168/98 mmHg, HR 92/min, RR 18/min, SpO2 98%. After lisinopril initiation, serum creatinine rises from 1.1 to 3.2 mg/dL within 5 days. Physical examination reveals a systolic abdominal bruit; no peripheral edema noted. Which diagnosis best explains his acute kidney injury?
- A)Minimal change disease
- B)Acute interstitial nephritis
- C)Renal artery stenosisGABARITO
- D)Acute tubular necrosis
- E)Autosomal recessive polycystic kidney disease
Explicação
Renal artery stenosis is correct. Atherosclerotic narrowing of the renal artery decreases perfusion pressure, stimulates renin release, and causes secondary hyperaldosteronism and refractory hypertension. ACE inhibition can acutely reduce glomerular filtration... Ver explicação completa e trilha adaptativa →