A 19 year old women with history of cystic fiborsis is admitted to the hospital for pseudomonas pneumonia. Afte one week she has increasing lethargy. Lab shwos serum creatinine of 4.3 and blood urea nitrogen of 40. There are brown, granular epithelial casts on urine microscopy. A renal biopsy is performed. 1. What renal pathology is occuring and what suggests that? 2. What morphological changes would be seen on electron microscopy and why? 3. What likely precepitated this case of ATN?

How do you remember renal physiology?
Use the mnemonic, A WET BED: A) maintenance of ACID-base balance; W) maintenance of WATER balance; E) balance of ELECTROLYTES; T) removal of TOXINS; B) control of BLOOD pressure; E) production of ERYTHROPOIETIN; and D) metabolism of vitamin D.