3rd year Clinical Nephrology Preceptorial

CASE:
DR, a 24/M, admitted with a chief complaint of sudden decrease in urine output.
One week prior to hospital consult, patient developed high-grade fever with associated
myalgia and prostration. There were no other accompanying symptoms. On history-taking
patient recalled wading in floodwater 2 weeks earlier.
On PE, the vital signs were as follows: BP 100/60 HR 107bpm RR 24 T 39.00C. Other
pertinent findings revealed conjunctival suffusion, dry oral mucosa, clear breath sounds and
bilateral calf tenderness.
Initial labs upon admission showed the following:
BUN 24.9 mmol/L
Crea 354 umol/L
Na 144 mmol/L
K
6.5 mmol/L
Ca
2.2 mmol/L
Phos 1.4 mmol/L

CBC: Hgb 132

UA: sp gr 1.030/pH 5.5/rbc 0-2/wbc 0-4
Hct 0.420
(-)protein/(-)sugar
wbc 17.2
(-)cast/(-)crystals
neutro 0.82
lympho 0.18 Leptodridot IgM (+)
plt 204

1. Give your complete diagnosis and the basis for your diagnosis.
2. What is the renal diagnosis for the above case? Give the basis for your diagnosis.
3. What other diagnostic tests/procedures will you request? Give the rationale behind
each.
4. Enumerate the problems present in this case and your plan of management for each.