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NBME 18 Answers

nbme18/Block 1/Question#4 (10.0 difficulty score)
a 35-year-old woman has congestive ...
prerenal azotemia๐Ÿ”,๐Ÿ“บ
tags: renal 

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submitted by nbmeanswersownersucks(122),

After the addition of furosemide, her BUN/Cr ratio went up to 38 and Fraction Excretion of Na < 1%. Both of those hint a prerenal azotemia. Which also makes sense since she has congestive heart failure which would decrease blood flow to the kidney and then taking a strong diuretic would lower her blood volume even more.

lokotriene  FA2020 p601 +  
lokotriene  UW:15207 Deals with this same concept and has a great explanation about the pathophys. +  
mariame  FA 2019 pg 590 +  

submitted by ih8payingfordis(9),

Why can't this be renal artery stenosis?

ngill  Renal artery stenosis in females is commonly due to fibromuscular dysplasia. You would see hypertrophy in the unaffected side, assuming it's unilateral. Additionally, the person would like have HTN with activation of the RAAS due to the stenosed side. This would increase renin and then increase aldosterone which should lower potassium. +  
jbrito718  renal artery stenosis is a cause of prerenal azotemia. the main cause here is the diuretic leading to volume depletion thus causing the azotemia. Renal artery stenosis is not implicated in this question +