A 62-Year-Old Hospitalized Man Is Evaluated for New-Onset Renal Failure

A 62-year-old hospitalized man is evaluated for new-onset renal failure.  The patient was admitted 3 days ago due to precordial chest pain.  He was found to have an elevated troponin I level but no ST-segment elevation on ECG.  Percutaneous catheterization revealed 3-vessel coronary artery disease, and no coronary interventions were performed.  The patient has continued to receive medical treatment while awaiting coronary artery bypass graft surgery.  Today, he was noted to have elevated blood urea nitrogen and serum creatinine levels.  The patient has had no fever, and blood pressure and heart rate have been within normal limits.  Physical examination shows no new findings.  Which of the following pathologic findings is most likely present in this patient?

A) Diffuse necrosis of the proximal tubular cells
B) Extensive crescents in the glomeruli
C) Fibrin-like material lining the arteriolar walls
D) Mononuclear cell infiltrate in the interstitium
E) Needle-shaped clefts in the arterioles

Correct Answer:

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