رجل عمره ٧٤ سنة عنده إسهال وقيء من ٣ أيام، ويأخذ فوروسيمايد وإيبوبروفين لآلام الركبة. وصل خاملاً، والضغط ٩٢/٥٦، والنبض ١١٢، والبول ١٥ مل/ساعة. الكرياتينين ارتفع من ١٫٠ إلى ٢٫٦، واليوريا مرتفعة كثيراً. ما النوع الأرجح لإصابة الكلى الحادة؟

A 74-year-old man has had diarrhoea and vomiting for 3 days and takes furosemide and ibuprofen for knee pain. He arrives lethargic; BP 92/56, HR 112, urine 15 mL/h. Creatinine rose from 1.0 to 2.6 with a markedly raised urea. What is the most likely type of acute kidney injury?

1. Intrinsic, from immune-mediated glomerulonephritis
2. Prerenal, from low blood volume and drug effects
3. Advanced chronic kidney disease needing transplant soon
4. Postrenal, from ureteric obstruction by a stone

Answer: B) Prerenal, from low blood volume and drug effects. Dehydration plus a diuretic and an NSAID reduce renal perfusion, causing prerenal injury. It usually improves with fluids and stopping harmful drugs if treated early.