NBME Step 2 CK Form 7 Blood: 1+; Protein: 1+; RBC: 0–5; WBC: 0–5; Casts: Pigmented granular; Other microscopic findings: Renal tubular epithelial cells (NBME Answers)

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NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 3/Question#41 (reveal difficulty score)
A 72-year-old man has decreased urine output ...
Blood: 1+;
Protein: 1+;
RBC: 0–5;
WBC: 0–5;
Casts: Pigmented granular;
Other microscopic findings: Renal tubular epithelial cells 🔍 / 📺 / 🌳 / 📖
tags: renal

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submitted by ∗step_prep5(246)

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Elderly patient with gram-negative bacteremia receiving gentamicin (aminoglycosides associated with acute tubular necrosis) who has developed oliguria and an AKI, most consistent with acute tubular necrosis
Acute tubular necrosis leads to pigmented granular casts
Causes of acute tubular necrosis: Sepsis, Aminoglycosides, ischemia/hypotension (spectrum of disease of pre-renal AKI), heavy metals, radiocontrast, ethylene glycol, rhabdomyolysis

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azibird Yes. But I'm suprised no one has mentioned this yet, because it makes the diagnosis a lot more certain: Cephalosporins increase nephrotoxicity of aminoglycosides - FA 2020 +1

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submitted by ∗seagull(1933)

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Acute Tubular Necrosis due to Aminoglycoside toxicity (Gentamicin).

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submitted by dreamyyn(10)

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in addition to the nephrotoxic medication, the DIC can lead to thrombosis and renal ischemia -> another cause of ATN

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submitted by ∗athleticmedic(18)

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Findings are consistent with acute tubular necrosis

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