Case 3: 74 year old female with renal impairment

Written by:
Waleed Ali, MD. Nephrology Fellow, University of Colorado, Denver, CO, USA
Reviewed by:
Ihab Babiker Abdalrahman, MD, Assistant Professor of Medicine, University of Khartoum, Sudan
Hatim A. Hassan, M.D., Ph.D. Assistant Professor, Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
Elmonttasir  Uthman, MD, Nephrology Fellow, Memorial University, Newfoundland,  Canada

 History

A 74 year old African American woman is seen in the outpatient clinic on a routine follow up visit. Her medical history is significant for type II diabetes mellitus and hypertension,  for which she has been treated  for the last thirty years. She had received several laser photocoagulation treatments for her eyes. She also has chronic back pain for which she has been ingesting 4 to 6 tablets of Ibuprofen daily for the past 4 years. Her medical regimen includes Amlodipine 5 mg, Atenolol 50 mg, Lisinopril 40 mg, Glipizide 5 mg, Cholecalciferol 1000 units all once daily as well as Furosemide 40 mg twice daily.

Physical Examination:

She is well-appearing and is in no apparent distress. Her pulse rate is 66/min, blood pressure is 166/90 and she is afebrile. Neck is supple without lymphadenopathy or thyromegaly. Heart is regular with normal S1 and S2 without added sounds and lungs are clear bilaterally. Abdomen is not tender or distended and she has no organomgaly. Lower extremities revealed trace edema and slight decreased sensation in a glove and stocking pattern.

Laboratory results:

 

Current

3 months ago

Normal values
Na (mmol/l)

147

136

136-145
K (mmol/l)

5.2

4.8

3.5-5
Cl (mmol/l)

113

109

98-106
HCO3 (mmol/l)

17

22

23-28
Urea (mg/dl)

98

75

8-20
Creatinine (mg/dl)

2.4

2.2

0.7-1.3

A non-fasting blood sugar was 200 mg/dL. ( fasting blood sugar normal range 70-105 mg/dl)

Dipstick urine testing revealed 2+ protein and the urinary sediment was bland.

A spot urinary protein was 145 mg/dL, creatinine was 66 mg/dL.

  1. The most likely cause of this patient's renal insufficiency is:
 

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