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. The client states that they consume a high calcium diet and have had high calcium in their blood. A high calcium diet or hypercalcemia is more associated with kidney stones, not typically with pyelonephritis.
B. The client reports that they had two urinary tract infections (UTI) in the past months. Recurrent UTIs are a risk factor for pyelonephritis, as untreated or recurrent infections can ascend from the bladder to the kidneys, leading to this condition.
C. The client states that they remember their mother saying their grandma had this same genetic disease. Pyelonephritis is not typically a genetic disease but rather an infection of the kidneys, often secondary to urinary tract infections.
D. The client reports that they took a lot of ibuprofen for arthritis for many years. Long-term NSAID use can impact kidney function but does not directly cause pyelonephritis.
Correct Answer is B
Explanation
A. High fluid intake: High fluid intake can help maintain blood flow and reduce the risk of venous stasis.
B. Immobility during and after surgery: Immobility contributes to venous stasis and is a primary risk factor for DVT, especially after prolonged surgery.
C. Low body temperature: Low body temperature does not directly cause venous stasis or increase the risk of DVT.
D. Increased physical activity: Increased physical activity promotes circulation and reduces the risk of DVT by preventing blood from pooling in the veins.