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  Tuesday, 02 April 2013
  4 Replies
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Hello experts, my question is about a patient 33 yrs old , who complained of fever , chills and severe loin pain one week ago . The patient went to hospital where he took analgesics and antibiotic therapy after which his loin pain gradually disappeared. he was kept on NSAIDs & local muscle relaxants . his creatinine was 1.4 mg%. the patient also suffered from upper respiratory infection in the form of acute bronchitis .7 days later his creatinine rised to 3.6 mg% .blood urea = 66 mg%, ACR was 336 mg alb/mg creat , urine analysis showed albuminuria , otherwise no pus cells , no RBCs . abdominal ultrasound was done showing no back pressure changes in the kidneys , with average size . Spleen was enlarged . s.uric acid was high = 10 mg / dl .clinically the patient blood pressure = 120/100 .no lower limb edema , the chest showed crepitations bilaterally.
11 years ago

The case is obviously concerning given the very significant deterioration in renal function happening over what appears to be a relatively short period. Beginning with the most common:

  1. May I ask if the NSAIDs were discontinued?
  2. Is he currently taking any other medications or possible nephrotoxins?
  3. Was the creatinine high BEFORE starting antibiotics and NSAIDs
  4. Have you tested him for ANCA or anti-GBM?

Thank-you for the interesting case,

Dr. Jordan Weinstein
11 years ago
Dear Dr. Jordan Weinstein ,
as regard NSAIDS , the patient was advised to stop immediately .his creatinine was 1.4 mg% before taking the medication .
no other labs were done .
does this patient need biopsy ?
11 years ago

It's hard to recommend an invasive test just based on the description above, without having all the facts of the case at my disposal. But certainly, he has significant undiagnosed renal failure, with possible pulmonary-renal involvement.

Did you mis-report the proteinuria levels above? You wrote 336 mg / mg creatinine. Did you mean 336 mg / g creatinine?

11 years ago
Dear Dr. Jordan Weinstein ,
Actually I mis-report the ACR . it is 336 mg alb/g creat.
thank you a lot ..
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