RT Book, Section
A1 Esquivel, Ernie L.
A2 Stern, Scott D.C.
A2 Cifu, Adam S.
A2 Altkorn, Diane
SR Print(0)
ID 1185666771
T1 Patient with Acute Kidney Injury - Case 3
T2 Symptom to Diagnosis: An Evidence-Based Guide, 4e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260121117
LK accessmedicine.mhmedical.com/content.aspx?aid=1185666771
RD 2025/01/17
AB PATIENT  Mrs.  F  is  a  63-year-old  woman  with  a  history  of  diastolic  dysfunction,  hypertension,  and  knee  and  hip  osteoarthritis.  Her  usual  medications  are  atenolol,  lisinopril,  and  acetaminophen,  and  her  baseline  serum  creatinine  is  1.1  mg/dL.  Four  weeks  ago,  she  came  to  your  office  with  severe  pain,  erythema,  and  swelling  of  her  right  first  metatarsophalangeal  joint.You  diagnosed  gout  and  prescribed  indomethacin  25  mg  3  times  daily  until  the  symptoms  resolved.  She  returned  for  a  follow-up  yesterday,  reporting  that  the  gout  had  resolved  in  a  few  days,  but  that  she  kept  taking  the  indomethacin  because  it  also  relieved  her  chronic  knee  and  hip  pain.  Despite  your  reservations,  you  agree  to  refill  the  prescription  because  she  clearly  feels  so  much  better  than  usual,  cautioning  her  to  use  the  medication  only  when  she  needs  it.  Today  you  receive  the  results  of  the  blood  tests  you  ordered  during  the  visit:  Na,  141  mEq/L;  K,  5.0  mEq/L;  Cl,  100  mEq/L;  HCO3,  20  mEq/L;  BUN,  32  mg/dL;  creatinine,  2.5  mg/dL.At  this  point,  what  is  the  leading  hypothesis,  what  are  the  active  alternatives,  and  is  there  a  must  not  miss  diagnosis?  Given  this  differential  diagnosis,  what  tests  should  be  ordered?