A 42-year-old man was admitted to the hospital for general
malaise and a rapidly rising creatinine.
His past medical history is remarkable for pulmonary tuberculosis,
treated one year ago with rifampicin and isoniazid. He discontinued the drugs
about six month ago. He was seen as an outpatient 10 days ago for persistent
productive cough, low-grade fever, and night sweats. A chest x-ray film showed focal
consolidations in the right upper lobe with two 2.5cm. cavitations. Cultures
were submitted and the patient was restarted on the tuberculostatic protocol.
At this time blood chemistries were all within normal limits, except for a
slightly elevated WBC count.
One week later he was seen as an outpatient. The laboratory
tests obtained at that time showed normal bilirubin, transaminase, and
phosphatase levels. His serum creatinine had risen from 0.9 mg/dl one week ago
to 3.8 mg/dl.
His urinary sediment was remarkable for numerous WBC,
granular casts, occasional RBC, epithelial cells, and trace protein. RBC cast
were not detected in several urine samples obtained during his first few days
in the hospital.
A renal biopsy was performed on the third day.
Questions:
What is the likely clinical diagnosis?
What will the biopsy show?
Questions:
What is the likely clinical diagnosis?
What will the biopsy show?
No comments:
Post a Comment