Progressive Renal Failure in a 24-Year-Old Man
James J. Matera, DO
Nephrologist, Senior Vice President for Medical Affairs, and Chief Medical Officer, CentraState Medical Center, Freehold, New Jersey
Matera JJ. Progressive renal failure in a 24-year-old man. Consultant. Published online June 10, 2021. doi:10.25270/con.2021.06.00006
Received May 25, 2021. Accepted May 25, 2021.
The authors report no relevant financial relationships.
James J. Matera, DO, CentraState Medical Center, 901 West Main Street, Freehold, NJ 07728 (JMatera@centrastate.com)
A 20-year-old man presented to the emergency department (ED) with a 3- to 4-week history of worsening dyspnea upon exertion, lower extremity edema, weakness, anorexia, and vomiting. He also reported that, over the last 4 years, he would have intermittent painless hematuria several times per year, not always associated with activity. Six months prior to admission, he reported a decreased visual acuity, as well as difficulty hearing, needing to turn up the volume on his mobile devices. He has not seen a physician since age 16 years when he needed a physical for school and reported no antecedent illnesses. He had tested negative for COVID-19 on 2 occasions and was not vaccinated against COVID-19.
Physical examination. Upon presentation, he was afebrile and had a normal pulse of 84 beats/min, increased respiration rate of 20 breaths/min, increased blood pressure of 154/88 mmHg, and an oxygen saturation of 94% on room air. No jugular vein distention was noted. His heart sounds were normal with an S1/S2 without rub, and his lungs had rales 1/3 on both sides.
A hepatojugular reflux was elicited, without abdominal ascites. Extremities had 3+ edema to the mid-thigh with pitting. Results of a neurological examination were within normal limits, but his cranial nerves were not tested.
A chest radiography scan was conducted, results of which revealed evidence of pulmonary edema (Figure). Results of an electrocardiogram showed a normal sinus rhythm without ST-T changes.
Figure. Results of a chest radiography scan showed pulmonary edema.
Laboratory testing. Results were significant for a low sodium level of 126 mEq/L, a high potassium level of 6.5 mEq/L, a low chloride level of 96 mEq/L, and a low total carbon dioxide level of 12 mEq/L. The following values were also elevated in this patient: anion gap, 18 mEq/L; blood urea nitrogen, 175 mg/dL; creatinine, 14.7 mg/dL; phosphorous, 10.7 mg/dL.
Results of an arterial blood gases test showed acidosis with a pH level of 7.22/21/58/10/88% on room air. Results of a urinalysis showed a normal urine specific gravity of 1.015, a normal pH level of 7.0, an abnormal 3+ protein level, an abnormal 4+ red blood cell count, and a significantly elevated level of red blood cells per high powered field of more than 50.
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