A 55 y.o. man with type 2 diabetes for 15 years presents with decreased urine output for 4 days. Baseline Cr=1.6 with 1.3 grams of protein on his last 24 hour urine. Meds: lisinopril and insulin. He had a cardiac catheterization 1 week ago. BUN/Cr = 20/5.0, K=6.1, BP is 190/110. His JVP is 9 cm, he has bibasilar crackles, and 1+ edema.
What is the differential for his renal failure and which is most likely?
A 40 y.o. IDU (IV heroin) is hospital day 7 for right-sided endocarditis treated with nafcillin and gentamicin. Your morning labs show creatinine of 4.0. His other meds are methadone 60 mg qd, and ibuprofen 600 tid for low back pain. He was dehydrated on admission (BUN 40/Cr 1.6) but now has good urine output and does not appear dehydrated on exam. UA shows 2+ protein.
A 69 y.o. man has been unable to urinate for the last 24 hours. He was recently started on amitriptyline for insomnia. His abdomen is distended and diffusely tender. He feels a slight urge to urinate when you palpate his suprapubic area.