A 20-Year-Old Man Is Brought to the Emergency Department with a One-Day

question 781

Multiple Choice

A 20-year-old man is brought to the emergency department with a one-day history of fever, headache, and altered mental status.  He has no history of medical illness.  Cerebral spinal fluid analysis shows lymphocytic pleocytosis, elevated protein level, and normal glucose level.  The patient is started on high-dose intravenous acyclovir.  Two days later, his neurologic status improves.  Polymerase chain reaction assay for herpes simplex virus DNA comes back positive.  However, the patient complains of nausea and abdominal discomfort.  He is afebrile, normotensive without orthostasis, and has normal oxygen saturation.  The rest of the physical examination is unremarkable.  Laboratory results are as follows: His admission creatinine level was 0.8 mg/dL.  Which of the following is the most likely cause of acute kidney injury in this patient?

• A)Acute interstitial nephritis
• B)Bladder neck obstruction
• C)Glomerular injury
• D)Prerenal azotemia
• E)Renal tubular obstruction

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