A 76-Year-Old Man Comes to the Office Due to Bilateral

A 76-year-old man comes to the office due to bilateral flank pain and nausea.  The patient has not urinated for 24 hours.  Medical history is significant for diet-controlled type 2 diabetes and degenerative arthritis of the knee.  He occasionally takes naproxen for pain.  Temperature is 36.9 C (98.4 F) , blood pressure is 140/90 mm Hg, and pulse is 90/min.  Cardiopulmonary examination reveals no abnormalities.  Abdominal examination shows suprapubic fullness.  Mild bilateral costophrenic angle tenderness is present.  Laboratory results show a blood urea nitrogen level of 32 mg/dL and creatinine level of 2.6 mg/dL.  Four weeks ago, laboratory studies were normal.  Which of the following is the most likely cause of this patient's renal dysfunction?

A) Diabetic nephropathy
B) Interstitial nephritis
C) Renal tubule injury due to ischemia
D) Renal tubule injury due to protein casts
E) Urethral compression

Correct Answer:

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