A. S. is a 70-year-old white woman who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A. S. stated that she has been able to do her daily chores at home independently, but for the last few days it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, diabetes mellitus type 2, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective DataHas been having headaches on and off, with nausea and dizzinessReported that she hadn’t been taking her medications regularly at home because of "forgetfulness"Has not been urinating a lotFeels "puffy" in her legs and handsObjective DataPhysical ExaminationBlood pressure 178/96, pulse 110, temperature 98.9° F, respirations 24Alert and oriented to person, place, and timeMild jugular venous distentionFine crackles in bilateral lower lobesHeart rate regular, no murmursBowel sounds normoactive and present in all four quadrants2+ edema bilateral lower extremities and handsDiagnostic StudiesEchocardiogram shows decreased left ventricular functionUrinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells24-hour urine output = 380 mLLaboratory Tests:Hemoglobin 8 g/dL abnormal result normal is 120-160 g/dlHematocrit 23.8%RBC 2.57 million/mm3 abnormal result …normal value isWBC 4.7 mm3Sodium 132 mEq/LPotassium 5.2 mEq/LCalcium 9 mg/dLBUN 36 mg/dLCreatinine 4.9 mg/dLBNP 182 pg/mL

Discussion Questions (total 12 marks)
1-Interpret A. S.’s laboratory test results and describe their significance. (2 marks)2-What is the most likely cause of A. S.’s AKI? (1 mark)