Audio Qbank – HY USMLE Q #527 – Internal medicine / Renal

A 54-year-old woman comes to the physician for a one-week history of increased swelling of her lower extremities and shortness of breath. She has history of type II diabetes mellitus and hypertension. Two weeks ago, she was treated for a urinary tract infection with amoxicillin. At the time, lisinopril was also commenced. Vitals are: temperature 98.6F, HR 110, RR 18, BP 180/100. Auscultation of the chest demonstrates an S3 heart sound and diffuse bilateral crackles. There is 2+ pretibial pitting edema bilaterally. Laboratory studies show:

Serum blood urea nitrogen                          50 mg/dL
Serum creatinine                                                4.1 mg/dL
Urine blood                                                            None

Which of the following is the most likely diagnosis?

Acute kidney injury
Interstitial nephritis
Obstructive uropathy
Pre-renal azotemia
Proliferative glomerulonephritis