A 65-Year-Old Hospitalized Man Is Evaluated for Decreased Urine Output

A 65-year-old hospitalized man is evaluated for decreased urine output and increased serum creatinine.  The patient was admitted for 3-vessel coronary artery disease and underwent coronary artery bypass grafting surgery yesterday.  Other medical conditions include type 2 diabetes mellitus and hypertension.  He received a dose of intravenous vancomycin prior to the surgery for prophylaxis of surgical infection.  The patient has also been receiving 100 mL/hour of intravenous normal saline for the past 24 hours.  He is afebrile.  Blood pressure is 130/80 mm Hg and pulse is 80/min.  Examination shows bibasilar crackles.  The abdomen is soft.  Urine output over the past 6 hours is 100 mL.  Laboratory results are as follows: Urine sediment microscopy is shown in the exhibit. 

Which of the following is the most likely cause of this patient's current condition?

A) Crystal obstruction in tubules
B) Drug toxicity to renal tubules
C) Glomerulonephritis
D) Interstitial inflammation
E) Ischemic tubular necrosis
F) Prerenal azotemia

Correct Answer:

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