A 22-year-old man with cystic fibrosis presents to the ED with the acute onset of fever, chills and dyspnea. Blood cultures are positive for Pseudomonas aeruginosa, and the patient is started on a multiple-antibiotic regimen of a β-lactam antibiotic and gentamicin. Ten days later, the patient’s bacteremia has resolved but his creatinine is 2.0 mg/dL. Urinalysis demonstrates muddy brown granular casts, and the fractional excretion of sodium in his urine is 2.5%. What is the most likely mechanism of this patient’s renal disease?
- (A) Decreased perfusion of the kidney secondary to volume depletion
- (B) Deposition of antibody and/or antibodyantigen complexes on the glomerular basement membrane
- © Direct toxic effect on renal tubule cells
- (D) Decreased perfusion of the kidney secondary to volume depletion
- (E) Renal arterial and arteriolar vasoconstriction
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