4.3 of 11 Ratings
A 63-year-old man undergoes uncomplicated laparascopic cholecystectomy for acute cholecystitis and is admitted to the surgical ward for postoperative management. On postoperative day 1, routine laboratory studies reveal an increase in serum creatinine to 1.46 mg/dL from 0.98 mg/dL before the operation; BUN is 37 mg/dL, increased from 18 mg/dL on prior measurement; K is 4.8 mEq/L and CO2 is 19 mEq/L. The patient has an indwelling urinary catheter in place, draining minimal urine over the last few hours. After ruling out urinary catheter obstruction, which of the following is the most appropriate next step in management?
Place a new urinary catheter
Administer IV fluid bolus
Obtain bilateral renal ultrasonography
Initiate emergent hemodialysis
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A 70-year-old man was diagnosed two days ago with a myocardial infarction and underwent percutaneous coronary intervention to reperfuse his left anterior descending artery. Two days later his creatinine is noted to be elevated (despite being normal the day before) and he complains of a "rash" on his foot (Figure A). Which of the following would most likely be found in laboratory studies?
Granular urinary casts
Elevated white blood count in urine