A 55-year-old woman with acute onset renal failure is evaluated on the ward. She presented with acute abdominal pain. Her abdominal pain was not proportionate to her physical examination findings. Therefore, she was sent for angiography which confirmed the diagnosis of acute mesenteric ischemia. Today, she was reported to have elevated blood urea nitrogen and serum creatinine levels. The patient does not complain of fever, dyspnea, or palpitations. She has stable vital signs. Physical examination shows no new findings. Which of the following pathologic findings is most likely present in this patient?

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Eductional Objective: Radiological contrast may alter the renal function, through contrast-induced nephropathy. Contrast-induced nephropathy leads to acute renal failure manifesting with an acute increase in creatinine and blood urea nitrogen. Microscopically it looks like acute tubular necrosis with diffuse necrosis of the proximal tubuli. Urinalysis usually shows muddy brown casts.

A 55-Year-Old Woman with Acute Onset Renal Failure Is Evaluated