<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:Nine days after being treated for a perforated gastric ulcer and sepsis, a 78-year-old woman develops decreased urinary output and malaise. She required emergency laparotomy and was subsequently treated in the intensive care unit for sepsis. Blood cultures grew Pseudomonas aeruginosa. The patient was treated with ceftazidime and gentamicin. She has type 2 diabetes mellitus, arterial hypertension, and osteoarthritis of the hips. Prior to admission, her medications were insulin, ramipril, and ibuprofen. Her temperature is 37.3C 99.1F, pulse is 80min, and blood pressure is 11575 mm Hg. Examination shows a healing surgical incision in the upper abdomen. Laboratory studies show:Hemoglobin count 14 gdLLeukocyte count 16,400 mm3Segmented neutrophils 60Eosinophils 2Lymphocytes 30Monocytes 6Platelet count 260,000 mm3SerumNa 137 mEqLCl- 102 mEqLK 5.1 mEqLUrea nitrogen 25 mgdLCreatinine 4.2 mgdLFractional excretion of sodium is 2.1. Which of the following findings on urinalysis is most likely associated with this patients condition?? A: WBC casts, B: Pigmented casts, C: Muddy brown casts, D: RBC casts, E: Waxy casts,  <response>: This is a clinical vignette about a 78-year-old woman with decreased urinary output and malaise 9 days after being treated for a perforated gastric ulcer and sepsis. She has a history of type 2 diabetes mellitus, hypertension, osteoarthritis, and was recently treated with antibiotics for Pseudomonas sepsis. Lab tests show elevated BUN and creatinine consistent with acute kidney injury. The question asks which urinalysis finding is most likely associated with her condition.Based on the clinical history, the most likely diagnosis is acute tubular necrosis ATN secondary to sepsisseptic shock leading to acute kidney injury. In ATN, the renal tubular epithelial cells are damaged, leading to muddy brown granular casts in the urine. Therefore, the correct answer is C.Choices A and D may indicate glomerular disease like glomerulonephritis, which is unrelated to her clinical presentation. Choice B may indicate liver disease. Choice E, waxy casts, are seen in chronic kidney disease, which she does not have.C: Muddy brown casts 