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 Renal failure- cardiac catheterization  

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A 72-year-old male develops acute renal failure after cardiac catheterization. Physical examination is notable for diminished peripheral pulses, livedo reticularis, epigastric tenderness, and confusion. Laboratory studies include (mg/dL) BUN 131, creatinine 5.2, and phosphate 9.5. Urinalysis shows 10 to 15 white blood cells (WBC), 5 to 10 red blood cells (RBC), and one hyaline cast per high-power field (HPF). The most likely diagnosis is
A. acute interstitial nephritis caused by drugs
B. rhabdomyolysis with acute tubular necrosis
C. acute tubular necrosis secondary to radiocontrast exposure
D. cholesterol embolization
E. renal arterial dissection with prerenal azotemia


i'll just go for D






by diagnosis of exclusion..

A) nephritis doesn't cause hematuria

B) trauma

C) unlikely

E) unlikely

remaining..D but some one can give a better expln..


Cholesterol embolisation can cause livedo reticularis but the peripheral pulses are not diminished in that case.

Cardiac cath is used to do a radiographic visualisation of narrowing of the coronaries and can cause ATN. Epigastric pain and confusion can be because of hyperkalemia that follows.

I'll wait to see more views. Sticking to C in the meantime.


The answer is D.

Cholesterol embolization (also known as atheroembolic renal disease) is characterized by pyuria, progressive renal failure (usually nonoliguric), and associated organ dysfunction (including bowel, pancreas, and CNS). Hypocomplementemia and eosinophiluria also may be seen. The urinalysis is not compatible with acute tubular necrosis because of the absence of granular casts.



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