A 65-year-old male patient presents with sudden onset of oliguria and signs of dehydration His blood pressure is 90/60 mmHg, heart rate is 110 bpm and he has poor skin turgor. Laboratory results show elevated blood urea nitrogen (BUN and creatinine levels. Which of the following is the most likely cause of his acute kidney injury (AKI)?
Hypovolemia leading to decreased renal perfusion
Acute tubular necrosis
Urinary tract obstruction
Chronic kidney disease
The Correct Answer is A
A. Hypovolemia leading to decreased renal perfusion. Hypovolemia from dehydration and low blood pressure reduces blood flow to the kidneys, resulting in pre-renal AKI, characterized by elevated BUN and creatinine.
B. Acute tubular necrosis. Acute tubular necrosis may cause AKI but is often due to prolonged hypoperfusion, nephrotoxic drugs, or ischemia, not the immediate presentation seen here.
C. Urinary tract obstruction. A urinary tract obstruction leads to post-renal AKI, often with symptoms like flank pain or difficulty urinating, not dehydration and low blood pressure.
D. Chronic kidney disease. Chronic kidney disease is a long-term condition and would not cause the acute symptoms or sudden onset of AKI as seen in this patient.
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Correct Answer is B
Explanation
A. Conjunctivitis. Conjunctivitis generally presents with redness and discharge but does not cause elevated intraocular pressure, severe pain, or visual disturbances like halos.
B. Acute angle-closure glaucoma. Acute angle-closure glaucoma is characterized by sudden severe eye pain, blurred vision, halos around lights, nausea, and vomiting, along with elevated intraocular pressure and a cloudy cornea.
C. Retinal detachment. Retinal detachment may cause sudden vision loss or flashing lights but typically lacks pain, nausea, or vomiting, and does not affect intraocular pressure.
D. Migraine with aura. A migraine with aura may cause visual disturbances but does not present with eye pain, red eye, or elevated intraocular pressure.
Correct Answer is D
Explanation
A. Warfarin. Warfarin (Coumadin) is an anticoagulant used to prevent blood clots, but it typically requires several days to achieve a therapeutic effect and needs close monitoring of INR (International Normalized Ratio) levels. While it can be used for long-term prevention of DVT, it's not the immediate choice for post-operative prophylaxis.
B. Alteplase (tPA). Alteplase is a thrombolytic agent, used to break down existing clots, not prevent their formation. It is typically used in emergency situations, such as for treating ischemic stroke.
C. Clopidogrel. Clopidogrel is an antiplatelet agent, often used to prevent arterial clots, not DVTs. It is more commonly used in conditions like stroke and heart disease.
D. Enoxaparin. Enoxaparin, a low molecular weight heparin, is commonly used to prevent DVT after surgery by inhibiting specific clotting factors. It’s frequently prescribed for DVT prevention in orthopedic surgery patients.