Renal Case: 62-year-old Woman with Nausea, Fatigue, and Lethargy

00:01 So that's vascular disease, let's move on to another case.

00:05 So you're asked to see a 62-year-old woman who was admitted with nausea, fatigue, lethargy and hemoptysis.

00:12 Her physical exam is remarkable for hypertension, she's 160/98 (mmHg) on her blood pressure result.

00:18 Her imaging shows a chest x-ray demonstrating bilateral interstitial infiltrates and on her laboratory data her serum creatinine is elevated to 3.6 (mg/dL) so we can see that that's quite high.

00:31 And her urine analysis shows proteinuria on dipstick and on microscopy she has dysmorphic red blood cells That means those red blood cells look very funny underneath the microscope, the membrane is getting deformed; and red blood cell cast.

00:46 So the question is, what type of acute kidney injury does this woman have? Let's go through the history and let's see if we can figure this out.

00:54 So importantly on the actual history, this patient is coming in with hemoptysis and taken together with her renal failure, her hematuria and proteinuria, highly suggestive of nephritic syndrome.

01:09 The other thing I think that's very important is her imaging results.

01:13 She's got bilateral interstitial infiltrates.

01:16 That again along with renal failure, very suggestive of what we call a pulmonary renal syndrome which are seen on glomerular diseases and nephritic syndromes.

01:26 And finally, just that we've been talking about, that hematuria with specifically funny red blood cells or dysmorphic-shaped red blood cells seen on microscopy along with those red blood cell casts and proteinuria, really clinches that diagnosis that this woman has nephritic syndrome and in this particular case, she actually has microscopic polyangiitis.