A 53-year-old Man With Disabling Arthropathy And Acute Renal Failure

Abstract

A 53-year-old Brazilian man came to our hospital because of intense oliguria beginning three days before admission. He was a chronic alcohol abuser, with previous diagnosis of type 2 diabetes, dyslipidemia, arterial hypertension, and deforming arthropathy. For one week, he had taken high dosages of indomethacin for bilateral arthralgia on the ankles, wrists, and metacarpophalangeal, metatarsophalangeal and interphalangeal joints. On admission, his BMI was 22.8 Kg/m 2 , and he presented with signs of bilateral acute arthritis in association with numerous asymmetric hard nodules on the periarticular soft tissues. Except for scars on the elbows and right knee, no change was found by examination of cutaneous or mucous surfaces, and nails. There were conspicuous deforming osteoarticular and subcutaneous changes (Figure). Laboratory data: urea 97.6 mg/dL, creatinine 2.4 mg/dL, uric acid 12.2 mg/dL, ionized calcium 1.06 mmol/L, sodium 135 mEq/L, potassium 3.5 mEq/L, magnesium 1.4 mg/dL, glucose 136 mg/dL, ALT 184.8 U/L, AST 291 U/L, albumin 3.66 g/dL, globulins 3.1 g/dL, total bilirubin 0.34 mg/dL, prothrombin activity 89%, INR 1.07; red cells 3.17x10 12 /L, hemoglobin 8.6 g/dL, hematocrit 26.5%, MCV 84 fL, white cells 4.2x10 9 /L, platelets 490 x 10 9 /L. Laboratory data after hydration and nutritional support: urea 42.5 mg/dL, creatinine 0.9 mg/dL, uric acid 8.1 mg/dL, ALT 85.2 U/L, AST 40.1 U/L; red cells 3.37x10 12 /L, hemoglobin 9.3 g/dl, hematocrit 29%, MCV 86 fL, white cells 5.8x10 3 /L, platelets 717 x10 9 /L; cholesterol 159 mg/dL, LDL 93 mg/dL, HDL 18 mg/dL. The images of the echographic study of the kidneys were unremarkable. With clinical improvement, the patient was referred to the Rheumatology outpatient surveillance.