A 32-year-old man presented with fatigue, decreased urine output, and shortness of breath. He had a recent hypertension diagnosis and a history of analgesic abuse. Examinations found elevated blood pressure and diminished lung sounds. Tests showed acute kidney injury, hyperkalemia, and pleural effusions. He was treated with hemodialysis, antibiotics, steroids, and antihypertensives. Over time his renal function and other markers improved, though remained abnormal. A renal biopsy was planned to determine the cause of his kidney disease.

2. Case presentation
By
Dr. Youssef El-Kholy
Egyption fellow-ship of Nephrology,
Nephrology Departement
Mansoura New General Hospital
(International)

3. Case history
• ổ pt , 32 yrs old , from mansoura came to our hospital on 27/6/2018
presented with fatigue,, decreased urine output and shortness of breath.
Present history
The condition started one week
before the patient came to our hospital ER by acute
onset and progressive course of easy
fatigability,,oliguria,,dyspnea and dysuria at the end of micturation
Past history
- Recently diagnosed HTN.
- No past history of DM or Renal Diseases

4. Drug History
Tramadol abuse(dose : ½tab of 225 mg daily for
6months).
- Analgesics abuser (6 yrs ago).

5. Family History
• No family history of renal diseases

6. Clinical examination
• General Examination:
Concious,alert and oriented with time,person
and place
BP:160/100
pulse:90/min,,regular,,equal in both sides,,no
special character

7. Clincal Examination
• Chest: bilateral diminshed air entry in basal
zones
NO LL. Oedema

8. Investigations at admission
( 27/6/2018 )
• CBC :
• HB: 6.9 gm/dl
• TLC: 24000
• PLT: 380000
• RFTS:
• S.CREAT. : 9.5 mg/dl
• Urea: 174 mg/dl
• Na: 139
• K: 6
• ABG :
• PH : 7.29
• PCO2 : 20
• H2CO3 : 9.6
• INR :1.57

9. Imaging
• Pelvi-abdominal U/S
• RT Kidney :
• Size : 11* 4.5 cm
• Parenchymal thickness : 1.8 cm
• Preserved CMD
• Increased echogenicity grade II
• LT Kidney :
• Size : 10.3 * 4.4 cm
• Parenchymal thickness : 1.5 cm
• Preserved CMD
• Increased echogenicity grade II

10. Chest X-Ray
• Bilateral Mild Pleural Effusion

11. Other investigations
• Urine Analysis:
pus cells:50 /HPF
Crp:48 mg/dl
ca:6.2
po4:10.1

12. D.D
• Drug Induced acute Interstitial Nephritis on
Top of CKD
Chronic Interstitial Nephritis

13. Management
• 4 Unsuccessive HD sessions Was done
Fluid Therapy Guided By Fluid Chart
(Urine output 400/24hrs----1000/24hrs----1950/24hrs)
Broad Spectrum Antibiotics
Low Dose Corticosteriods (prednisolone 30mg daily)
Antihypertensive Drugs

14. 3/7/2018

15. • CBC :
• HB: 7gm/dl
• TLC: 10.6
• PLT: 170
• RFTS:
• S.CREAT. : 6.4 mg/dl
• Urea: 156 mg/dl
• Na: 140
• K: 5.6
• Ca :7.7
• ABG :
• PH : 7.36
• PCO2 : 32
• H2CO3 : 18
• INR :1.26
Investigations on 3/7/2018

16. 7/7/2018

17. Investigations
on( 7/7/2018 )
• CBC :
• HB: 7.8 gm/dl
• TLC: 7.30
• PLT: 135
• RFTS:
• S.CREAT. : 8.3 mg/dl
• Urea: 132 mg/dl
• Na: 135
• K: 5.5
• Ca :7.1
• ABG :
• PH : 7.33
• PCO2 : 23
• H2CO3 : 12.7
• INR : 1.31
• PO4 : 8.2
• Alb : 3.2
• input : 1500 , output : 1950 , BL pressure : 150/100

18. 13/7/2018

19. Investigations
on ( 13/7/2018 )
• CBC :
• HB: 7.9 gm/dl
• TLC: 5.1
• PLT: 116
• RFTS:
• S.CREAT. : 6.8 mg/dl
• Urea: 133 mg/dl
• Na: 124
• K: 5.4
• Ca : 7.5
• ABG :
• PH : 7.33
• PCO2 : 27
• H2CO3 : 14.2
• INR : 1.2
• PO4 : 6.2

20. Last Investigations
• RFTs
Urea :224 mg/dl
creat. :10.1 mg/dl
Na:134
K:6.5
CBC:
Hb:7.3 gm/dl
TLC:8700
PLT:171000
urine analysis:
pus cells:8/HPF

21. •Preparation For Renal
Biopsy

22. Thank you
Dr. Youssef El-Kholy