Kamsi
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A 43-year-old woman presents with back pain and is evaluated for renal insufficiency. Infection with HIV was diagnosed 2 years ago, and the patient began taking highly active antiretroviral therapy with zidovudine, lamivudine, and indinavir 1 year later because of a decreasing CD4 count and development of oral candidiasis. Six months ago, she developed fasting hyperglycemia and hypercholesterolemia and was treated with rosiglitazone and atorvastatin.
Physical examination reveals a blood pressure of 130/85 mm Hg and a pulse rate of 88/rn in that is regular, with no orthostatic changes. The respiratory rate is 18/min, and ternperature is 37.8 °C (100 °F). There is no neck vein distention or hepatojugular reflux. The cardiac, pulmonary, and abdominal exarninations are normal, but 2+ lower extremity ederna is present.
Laboratory studies:
Blood urea nitrogen 22 mg/dL
Serum sodium 141 rneq/L
Serum potassium 6.0 meq/L
Serum chloride 101 meq/L
Serum bicarbonate 19 meq/L
Serum creatinine 3.2 mg/dL
Serum calcium 7.2 mg/dL
Serum phosphate 8.3 mg/dL
Serum uric acid 9.0 mg/dL
Serum total cholesterol 177 mg/dL
Fasting blood glucose and glycosylated hemoglobin concentrations are elevated. Hematocrit is 31%, with an elevated mean corpuscular volume. Leukocyte count is 3300/μL, but platelet count is normal. Urinalysis reveals specific gravity 1.010, trace proteinuria, 2+ hematuria, and no ketonuria or glycosuria. Microscopic examination shows muddy brown casts and tubular epithelial cells, but no erythrocytes or crystalluria.
What is the most probable diagnosis?
A. Rhabdomyolysis caused by atorvastatin therapy
B. Indinavir nephrolithiasis
C. Indinavir tubulointerstitial renal disease and atrophy
D. HIV-associated nephropathy
E. Diabetic nephropathy
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| dr.wad
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A
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| darkhorse
Forum Elite
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hmmm...tricky one...picture is very much of interstitial nephritis....i will go for ccccccccc
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| drdg
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1.Patient has high K, high Serum phosphate and low Ca.
2. muddy brown casts and tubular epithelial cells
Those are specific for ATN. The only possibility is A. Rhabdomyolysis caused by atorvastatin therapy .
I will go to AAAAAA
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| AAAAA
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AAAAA
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| jvo_md
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Thats C the answer
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| neuroblastoma
Forum Guru
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yes A. RHABDOMYLYSIS --- no microscopin hematuria.(rbc absent)
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| sprint123
Forum Guru
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tHAT WAS a good finding neuroblastoma.....Muddy granular casts PATHOGNOMONIC of ATN.--->A
I was thinking that side effect of statins is myositis and not Rhabdomyolysis..Is the back pain of this patient is attributed to rhabdomyolysis?
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