MRCP2-3900

MRCP2-3900

A 45-year-old man with alcoholic liver disease and portal hypertension presented with confusion and a distended abdomen. He was taking propranolol, spironolactone, vitamin B12, and thiamine. Intravenous fluids and lactulose were administered, and a renal scan was normal. However, on the fourth day of admission, a ward registrar noted an acute kidney injury based on the following blood results:

– Urea: 8.0 mmol/l (normal range: 2.5-7.0)
– Creatinine: 150 µmol/l (normal range: 60-110)

Additional urine tests revealed:

– Sodium: 60 meq/l
– Protein: 250 mg/24 hours
– Osmolality: 800 mOsm/kg

Microscopic examination of the urine showed granular casts and renal epithelial cells. What is the most likely cause of this patient’s acute kidney injury?