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1. A 65-year-old man with a history of hypertension, diabetes mellitus,
and chronic kidney disease (CKD) stage 3 presents to the
emergency department with dyspnea, orthopnea, and bilateral
crackles on chest auscultation. His blood pressure is 180/100
mmHg, pulse is 110 beats/min, respiratory rate is 28 breaths/min,
and oxygen saturation is 90% on room air. His serum creatinine is
2.5 mg/dL and blood urea nitrogen (BUN) is 50 mg/dL. What is the
most likely diagnosis for this patient?
 - A) Acute kidney injury (AKI) due to volume overload
 - B) AKI due to contrast-induced nephropathy
 - C) AKI due to acute tubular necrosis
 - D) CKD exacerbation due to heart failure*
 - Rationale: The patient has signs and symptoms of heart failure,
which is a common cause of CKD exacerbation. Heart failure can
lead to reduced renal perfusion, increased venous pressure, and
activation of neurohormonal pathways that worsen renal function.
Volume overload, contrast-induced nephropathy, and acute tubular
necrosis are possible causes of AKI, but they do not explain theÂÂ
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