What situation(s) may cause an intrarenal acute kidney injury (AKI)? (Select all that apply)

Choice A reason: Decreased hydrostatic pressure reduces fluid movement out of capillaries, favoring fluid return to the intravascular space. Low plasma proteins affect oncotic, not hydrostatic, pressure, causing fluid to leak into tissues, not return to vessels, making this incorrect.

Choice B reason: Increased hydrostatic pressure, as in heart failure, pushes fluid into the interstitial space. Low plasma proteins reduce oncotic pressure, not hydrostatic, leading to edema via a different mechanism, making this choice incorrect for the described scenario.

Choice C reason: Low plasma proteins, like albumin, decrease oncotic (osmotic) pressure, reducing the force pulling fluid into capillaries. This causes fluid to move from the intravascular to the interstitial space, leading to edema, making this the correct choice.

Choice D reason: Increased osmotic pressure would pull fluid into the intravascular space, as with high plasma protein levels. Low plasma proteins decrease oncotic pressure, causing fluid to leak into tissues, not return to vessels, making this choice incorrect.

Choice A reason: Smoking introduces carcinogens like polycyclic aromatic hydrocarbons, damaging DNA and promoting mutations in lung, throat, and other tissues. Chronic exposure increases cancer risk, particularly lung cancer, by disrupting cellular repair mechanisms, making this a correct risk factor.

Choice B reason: Obesity increases cancer risk through chronic inflammation and hormonal imbalances, like elevated estrogen, linked to breast and endometrial cancers. However, it is not listed in the provided options, so it cannot be selected, though it is scientifically relevant.

Choice C reason: Tanning without sunscreen exposes skin to UV radiation, causing DNA damage in melanocytes and increasing melanoma risk. UV-induced mutations disrupt cell cycle regulation, promoting uncontrolled cell growth, making this a correct cancer risk factor.

Choice D reason: Human papillomavirus (HPV) causes cancers like cervical and oropharyngeal by integrating viral DNA into host cells, disrupting tumor suppressor genes. Chronic infection leads to cellular transformation, making this a correct risk factor for specific cancers.

Choice E reason: Family history of cancer indicates genetic predispositions, such as BRCA mutations, increasing risks for breast, ovarian, or other cancers. Inherited mutations impair DNA repair or cell cycle control, making this a correct risk factor for cancer development.