A 72 year old man presents to A&E with a 6 week history of arthralgia and myalgia. He notes that his urine has been dark for the last few days and he has been getting short of breath with ankle swelling. He has a history of peptic ulcer disease and rheumatoid arthritis but has been quite well until the last couple of months. A year ago his U&E was normal with creatinine 90.
His BP is elevated at 158/95 and his urinalysis shows Blood 4+ and Protein 3+.
He now has a creatinine of 320 and a urea of 19. His potassium is also elevated at 5.6. His Haemoglobin is 13.0g/dl and his calcium and phosphate are normal.
Your registrar isn't sure what is going on and you are asked to get a consult from the renal team.
You would like to be able to give a differential diagnosis when contacting the renal team. Do you think that this man has acute or chronic renal failure?
(a) Acute Renal Failure
(b) Chronic Renal Failure
What do you think is the cause of his renal failure?
So, his renal ultrasound shows no obstruction, and thus the most likely cause of his renal impairment is one of "Renal" ARF.
What type of disease is this going to be?
(a) Acute tublar necrosis
(c) Acute interstitial nephritis
(d) Acute pyelonephritis
[To revise: Open the previous list of Renal causes of AKI in a new tab/window].