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Renal Lab 1: Diseases Affecting Tubules, Interstitium, Vessels
Renal Lab 1: Diseases Affecting Tubules, Interstitium, Vessels
Case 1: A 54-year-old man (82kg) presents to the E.R. with malaise, fatigue and oliguria two days
after serving on a pit-crew during the Indianapolis 500 race. Despite sunny skies and temperatures
that hovered in the 90’s, he wore a full-body, fire-proof insulated suit and helmet so the he could
change tires for a car that placed 28th out of 33 cars. He drank three 24-ounce bottles of purified
water (2.1 liters) over eight or nine hours that day. He appears pale and his heart rate is 90/min, BP
108/60 mmHg, temperature 99.8F but he has no other physical findings. A stat serum creatinine =
5.8mg/dL, BUN = 70 mg/dL and hematocrit = 49%. You admit the patient and observe that over the
next eight hours he has made only 60cc of urine and his serum creatinine is now 6.3 mg/dL.
Questions:
1. What is the most likely reason for decreased urine output?
Questions:
1. What is the differential diagnosis associated with this acute clinical presentation?
2. How can you clinically distinguish between the categories of pre-renal, renal and post-renal?
3. If you suspect that tacrolimus is the cause of acute renal failure, how is the diagnosis made?
How would you treat the patient?
4. When is it appropriate to biopsy the patient and what might the renal biopsy show?
Case 3: An 18-year-old female presents with complaints of a diffuse rash. Ten days ago the patient
was prescribed cephalexin for a lower extremity cellulitis that developed after scratching a mosquito
bite. She states the cellulitis improved but yesterday when a rash appeared on her chest and legs she
started taking ibuprofen. On exam the patient has a temperature of 101.5 F and a diffuse
erythematous maculopapular rash. Her serum creatinine is 2.5 mg/dl and differential white blood cell
count reveals 10% eosinophils (absolute count 1000).
Questions:
1. What would you expect to see on urinalysis?
Questions:
1. You refer the patient to the ER where your fellow intern sees this patient. What would be
important signs to elicit on physical exam?
4. The next morning, with excellent management, the BP is 156/92 mmHg and serum creatinine
is 2.9 mg/dL. What would you do next?
6. The patient is scheduled for follow-up with his primary care physician in one week. What other
studies would be appropriate as an outpatient?