Altered Mental Status and Renal Failure in a 58-Year-Old Woman

Taylor, Sara; Yau, Jonathan
September 2010
Laboratory Medicine;Sep2010, Vol. 41 Issue 9, p517
Academic Journal
Case Study
Clinical History Patient: A 58-year-old Caucasian female Chief Complaint: Altered mental status, fever. Also complains of occipital headache and neck pain. History of Present Illness: Patient had presented to the emergency department 11 days previously with intermittent altered mental status, which was felt to be secondary to hyponatremia caused by treatment for hypertension with a thiazide diuretic. Upon resolution of her hyponatremia, the patient's altered mentation improved and she was discharged. Her present complaint is an altered mental status that has returned in conjunction with fevers and chills. She presented to the emergency department for further evaluation of a 3-day history of worsening altered mental status, most notably overnight. Past Medical and Surgical History: History of end-stage renal disease secondary to polycystic kidney disease status post renal transplantation in 2005. History of hypertension and hyperlipidemia. Surgical history included a bilateral nephrectomy, renal transplant, and a total abdominal hysterectomy. Family History: Polycystic kidney disease. Social History: Patient admitted to occasional social alcohol intake; denied tobacco and recreational drug use. Physical Examination Vital Signs: Temperature, 100.1°F; pulse 93 beats per minute; respiratory rate, 16 breaths per minute; blood pressure, 154/82 mmHg. The patient was a well-nourished Caucasian woman of normal weight. The patient was in mild distress from pain. Principal Laboratory Findings: Table 1Results of Additional Diagnostic Procedures and Tests CT (head): negative Cultures Urine: E. coli > 100,000 Blood: E. coli CSF: No growth at 6 days Lumbar Puncture Protein: 30 (NR=15-45 mg/dL) Glucose: 34 (NR=40-70 mg/dL) CSF WBC: 3 (NR=0-5) CSF RBC: 0 (NR=0) VDRL: nonreactive H. simplex (PCR): negative Cryptococcal ag: none detected TSH: 1.75 (NR=0.34-5.60 uIU/mL) B12: 1500 (NR=157-1059) Ammonia: 27 (NR=11-35 umol/L) RPR: nonreactive Kidney, Left, Core Biopsy: Final pathologic diagnosis: marked acute and chronic interstitial and tubular inflammation with focal necrosis consistent with acute pyelonephritis. There appears to be mild acute cellular rejection.


Related Articles

  • Diagnosis and Treatment of Idiopathic Thrombocytopenic Purpura. Kahanov, Leamor; Eberman, Lindsey E.; Grammer, Shaun // International Journal of Athletic Therapy & Training;Mar2012, Vol. 17 Issue 2, p25 

    The article discusses the condition of idiopathic thrombocytopenic purpura (ITP), its diagnosis and treatment in young adults. It refers to ITP as an antibody response to proteins on platelets that lead to their destruction and diminished platelet production and its symptoms may include...

  • Diagnosis and management of chronic ITP: comments from an ICIS expert group. Grainger, John David; Bolton-Maggs, Paula H. B.; Godeau, Bertrand; Bussel, Jim; Donato, Hugo; Elalfy, Mohsen; Hainmann, Ina; Matzdorff, Axel; Müller-Beissenhirtz, Hannes; Rovó, Alicia; Tichelli, Andre; Müller-Beissenhirtz, Hannes; Rovó, Alicia // Annals of Hematology;Jul2010, Vol. 89, p11 

    Immune thrombocytopenia (ITP) is a common disorder in children and adults. In a patient with newly diagnosed ITP, the treatment strategy is relatively well defined. Second-line treatments are more controversial, and the management of chronic ITP is even more so. During the 3rd ICIS Expert...

  • An Algorithmic Approach to the Diagnosis and Management of the Thrombotic Microangiopathies. Bendapudi, Pavan K.; Makar, Robert S. // American Journal of Clinical Pathology;Feb2016, Vol. 145 Issue 2, p152 

    The authors present insights on an algorithmic approach to the diagnosis and treatment of thrombotic microangiopathies (TMA). Topics discussed include the important role played by clinical pathologists in the care of patients with TMA, the central dilemma faced by physicians in treating patients...

  • Immune thrombocytopenic purpura develops in a 67-year-old female. Pennington, Mackenzie L.; Essary, Alison C. // JAAPA: Journal of the American Academy of Physician Assistants (;Dec2011, Vol. 24 Issue 12, p41 

    The article presents a case study of a 67-year old female, who suffers from oral petechiae and a single episode of epistaxis. It mentions that prescription medications will include alendronate, conjugated estrogens, and oxybutynin. Moreover, it notes that the patient was treated with...

  • Quick Recertification Series. Shearin-Patterson, Tonya; Davidson, Emily J. // JAAPA: Journal of the American Academy of Physician Assistants (;Apr2013, Vol. 26 Issue 4, p46 

    The article discuses some blood disorders. Von Willebrand disease (vWD) is a disorder of primary hemostasis -with mild to moderate bleeding which increases after minor trauma; cryoprecipitate may be required for severe bleeding. In idiopathic thrombocytopenic purpura (ITP) increased bleeding is...

  • Diagnosing rashes, part 7: Purpuric rashes. Watkins, Jean // Practice Nursing;Jan2014, Vol. 25 Issue 1, p23 

    The article offers information on the diagnosis of purpuric rashes. It discusses the symptoms and management of several platelet disorders such as idiopathic thrombocytopenic purpura (ITP) and secondary thrombocytopenic purpura. Vascular disorders like Henoch-Schonlein purpura and...

  • Safety and Efficacy of Romiplostim in Patients with Severe, Chronic Idiopathic Thrombocytopenic Purpura. Meyer, Oliver; Salama, Abdulgabar // Clinical Medicine Insights: Therapeutics;2012, Issue 4, p75 

    Abstract: Immune Thrombocytopenia (ITP) is an autoimmune disorder characterized by autoantibody-mediated destruction of platelets. In general, the goal of therapy is the prevention of bleeding complications. Since the risk of life-threatening bleeding complications (eg, intracranial hemorrhage)...

  • Author Reply. Rehman, Abdul // Turkish Journal of Hematology;Sep2008, Vol. 25 Issue 3, p1592 

    A response by Dr. Abdul Rehman to a letter to the editor about his article which is related to the practical management of acute immune thrombocytopenic purpura in children.

  • Off-Label Drug Uses - Romiplostim: Idiopathic Thrombocytopenic Purpura (Children/Adolescents). Generali, Joyce A.; Cada, Dennis J. // Hospital Pharmacy;Oct2011, Vol. 46 Issue 10, p755 

    The article features the study on the article "Off-Label Drug Facts," that was published in the periodical "Hospital Pharmacy." It presents the introduction of idiopathic thrombocytopenic purpura (ITP) which is commonly known as primary immune thrombocytopenia. It mentions that a controlled...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics