A 17-year-old boy is involved in a motor vehicle accident in which he sustains severe blunt trauma to the lower extremities. Over the next 3 days he develops oliguria and dark brown urine. A urine dipstick (tests for different substances in the urine) is positive for myoglobin. Microscopic examination of the urine reveals no red blood cells or leukocytes, but dark brown casts. His BUN is very elevated and he undergoes dialysis for 3 weeks. His condition improves and after another few weeks his urine output and BUN returns to normal. This patient had most likely developed: Acute pyelonephritis from a descending infection Acute pyelonephritis from an ascending infection Acute tubular injury Malignant nephrosclerosis Severe glomerular injury
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These findings suggest rhabdomyolysis, which is the breakdown of muscle tissue releasing myoglobin into the bloodstream. Myoglobin is toxic to the kidneys and can cause acute tubular injury (ATI). Show more…
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P.W. is 23 years old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. P.W.'s vital signs and hematocrit suggest that he has had a blood loss of about 2500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium. Analyze this case study and answer the next four questions that follow. Case-3: Question-4 If P.W.'s renal function does not return to normal, but continues to be diminished, what renal disorder might develop? (select all that apply) A) He may develop nephrotic syndrome B) He may develop renal calculi. C) He may progress to acute tubular necrosis. D) He may develop pyelonephritis
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Adi S.
A healthy 26-year-old woman sustained a significant crush injury to her right upper extremity while on the job at a local construction site. She was brought to the emergency department and subsequently underwent pinning and reconstructive surgery and received perioperative broad-spectrum antibiotics. Her blood pressure remained normal throughout her hospital course. On the second hospital day, a medical consultant noted a marked increase in her creatinine, from 0.8 to 1.9 mg/dL. Her urine output dropped to 20 mL/h. Serum creatine kinase was ordered and reported as 3400 units/L. Questions: What are the primary causes of this patient's acute kidney injury? How should her kidney injury be categorized (as prerenal, intrarenal, or postrenal)? How should she be treated?
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