Progressive Renal Failure in a 24-Year-Old Man

AUTHOR:
James J. Matera, DO

AFFILIATION:
Nephrologist, Senior Vice President for Medical Affairs, and Chief Medical Officer, CentraState Medical Center, Freehold, New Jersey

CITATION:
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.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
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.

Answers and discussion on next page.