Case 26: Next Steps

Case 26 Index

The patient receives an intravenous fluid bolus of normal (0.9%) saline. Unfortunately, she remains hypotensive and is transferred to the intensive care unit. Her chest x-ray reveals a multifocal pneumonia. On day two of her hospitalization, she further decompensates and requires intubation. She receives more intravascular resuscitation but norepinephrine is required for persistent hypotension. Her urine output is now less than 10 mL per hour.

The patient has repeat labs sent.
Urinalysis/microscopy, urine electrolytes
Urine sediment
Basic labs
Basic Lab Ref
Has your differential changed? What is your leading diagnosis now (choose 1)?
Acute interstitial nephritis (AIN)
Hypovolemia
Cardiorenal syndrome 
Hepatorenal syndrome
Thrombotic microangiopathy (TMA) 
Congestive heart failure 
 
Acute tubular necrosis (ATN)
Rapidly progressive glomerulonephritis (RPGN)
Urinary tract obstruction
Nephrotic syndrome

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