A 55-Year-Old Woman Comes to the Physician for an Annual

question 788

Multiple Choice

A 55-year-old woman comes to the physician for an annual physical examination.  She has no new complaints, except fatigue.  She has an 8-year history of chronic low back pain; severe degenerative joint disease has been documented on MRI.  She had an anterior wall myocardial infarction four years ago.  Her current medications include naproxen, acetaminophen, oxycodone, aspirin, atenolol, and simvastatin.  Her blood pressure is 130/80 mm Hg and pulse is 72/min.  Laboratory studies show: Serum protein electrophoresis is negative for monoclonal gammopathy.  Two years ago, her BUN level was 22 mg/dL, and creatinine level was 1.6 mg/dL.  Which of the following is the most likely pathology involved in this patient's renal failure?

• A)Acute tubular necrosis
• B)Chronic glomerulonephritis
• C)Tubulointerstitial nephritis
• D)Recurrent pyelonephritis

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