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You admit a 46-year-old woman, who is your medical partner's patient, to the hospital for the evaluation of an acute deterioration in renal function. She was seen by your partner, who is now on vacation, 2 days earlier for some mild upper respiratory complaints including sore throat, cough, and fever. He prescribed cephalexin and sent her home. Today, as you are reviewing all of the laboratory data that returned in the past couple of days, you notice that this patient has a blood urea nitrogen level of 67 mg/dL and a creatinine level of 2.1 mg/dL. You call her and tell her to meet you at the hospital for further evaluation. On admission her blood urea nitrogen level is 109 mg/dL and creatinine level is 4.2 mg/dL. The most appropriate study to order at this time is

A. serum electrolytes, including phosphate and calcium


B. serum lipid profile


C. 24-hour urine for protein and electrolytes


D. urine for sediment analysis


E. urine eosinophils

eee,check out for interstitial nephritis.

try again neversaydie4

ccccc

then it can be ccc

no try again...

ig a nephropathy? harry

DDD to rule out ATN?

bun/creatinin around 20:1 so , u may be correct neversaydie

Answer: A
In any case of rapidly deteriorating renal function, the substances normally cleared and regulated by the kidneys will be acutely deranged and must be evaluated. This step is critical because irrespective of the etiology of the renal failure, these abnormalities will be present. The findings of hyperkalemia, hyperphosphatemia, acidosis, or uremia will prompt immediate intervention prior to any diagnostic evaluation being undertaken.

Twenty-four hour urine for protein and electrolytes (choice C) is a non-emergent test used to quantify the amount of protein and other substances being lost by the kidney each day.

Urine eosinophils (choice E) is a non-emergent test most often ordered when drug-induced acute interstitial nephritis (AIN) is suspected