Comprehensive Acute Renal Failure (ARF) Case Study

This is not a real patient chart. The names and data have been created.

Patient Chart

Patient Name: Gregory James Thornton
Date of Birth: 02/14/1976
Age: 49
Gender: Male
Medical Record Number: 20250309
Date of Admission: 03/09/2025
Primary Care Provider: Dr. Emily Clark

Chief Complaint (CC)

"I’ve been feeling weak and my urine output has decreased. My legs are swelling up and I feel nauseous."

History of Present Illness (HPI)

Gregory Thornton is a 49-year-old male who presents with complaints of generalized weakness, decreased urine output, bilateral lower extremity edema, and nausea for the past 4 days. The patient notes that he has been feeling fatigued and has experienced a significant reduction in the amount of urine he is producing. He also reports feeling nauseous and has vomited several times. His legs have been swelling up, especially at night, and the swelling has progressively worsened.

The patient was recently hospitalized for a severe urinary tract infection (UTI) and was treated with oral antibiotics. He has a history of type 2 diabetes mellitus and hypertension, both of which are managed with medication. He has also been on a nonsteroidal anti-inflammatory drug (NSAID) for chronic back pain, which may have contributed to the current condition.

Past Medical History (PMH)

  • Type 2 Diabetes Mellitus – diagnosed 8 years ago, controlled with Metformin
  • Hypertension – diagnosed 10 years ago, controlled with Lisinopril
  • Chronic Low Back Pain – managed with Ibuprofen 400 mg daily
  • Obesity – BMI of 32

Surgeries & Procedures

  • Appendectomy at age 20
  • Knee Arthroscopy at age 35 for meniscal tear

Allergies

  • No known drug allergies

Medications

  • Metformin 500 mg twice daily
  • Lisinopril 10 mg daily
  • Ibuprofen 400 mg daily for chronic back pain
  • Multivitamins daily

Family History (FH)

  • Father: Alive, 72, with hypertension and coronary artery disease
  • Mother: Alive, 70, with type 2 diabetes mellitus and osteoarthritis
  • Sister: Alive, 45, healthy

Social History (SH)

  • Smoking: Occasional smoker (5 pack-years), quit 3 years ago
  • Alcohol: Drinks socially (2-3 drinks per week)
  • Drug Use: Denies illicit drug use
  • Occupation: Desk job (office worker)
  • Living Situation: Lives with wife and two children

Review of Systems (ROS)

  • General: Fatigue, weight gain (from edema), no fever
  • Cardiovascular: No chest pain, occasional palpitations
  • Respiratory: No shortness of breath or cough
  • Gastrointestinal: Nausea, vomiting, no diarrhea
  • Genitourinary: Decreased urine output, swelling in legs
  • Musculoskeletal: Chronic low back pain, no recent trauma

Physical Assessment Findings

Vital Signs:

  • Temperature: 98.7°F (37.0°C)
  • Heart Rate: 98 bpm, regular
  • Respiratory Rate: 18 breaths/min
  • Blood Pressure: 160/95 mmHg
  • Oxygen Saturation: 97% on room air
  • Height: 6'1"
  • Weight: 200 lbs.

General Appearance: Overweight male, appears fatigued and uncomfortable
Cardiovascular: Regular heart rate and rhythm, bilateral lower extremity edema (up to knees), no jugular venous distention
Abdomen: Soft, non-tender, no hepatomegaly or splenomegaly, no ascites
Genitourinary: Decreased urine output, dark yellow urine
Musculoskeletal: No joint deformities or signs of trauma
Neurological: Alert and oriented, no focal deficits

Laboratory Results

Basic Metabolic Panel (BMP)

Test Result Reference Range
Sodium (Na) 136 mEq/L 135-145 mEq/L
Potassium (K) 5.8 mEq/L 3.5-5.1 mEq/L
Chloride (Cl) 100 mEq/L 98-107 mEq/L
Bicarbonate (HCO₃) 18 mEq/L 22-28 mEq/L
Blood Urea Nitrogen (BUN) 42 mg/dL 7-20 mg/dL
Creatinine (Cr) 3.5 mg/dL 0.6-1.2 mg/dL
Glucose (fasting) 118 mg/dL 70-99 mg/dL

Complete Blood Count (CBC)

Test Result Reference Range
White Blood Cell Count (WBC) 10.8 x10³/µL 4.0-11.0 x10³/µL
Hemoglobin (Hgb) 14.0 g/dL 12.0-16.0 g/dL
Hematocrit (Hct) 42% 36-46%
Platelets (Plt) 250 x10³/µL 150-450 x10³/µL

Liver Function Tests (LFTs)

Test Result Reference Range
Alanine Aminotransferase (ALT) 35 U/L 10-40 U/L
Aspartate Aminotransferase (AST) 32 U/L 10-40 U/L
Alkaline Phosphatase (ALP) 110 U/L 45-115 U/L
Bilirubin, Total 0.9 mg/dL 0.1-1.2 mg/dL

Coagulation Profile

Test Result Reference Range
Prothrombin Time (PT) 12.5 seconds 11-13.5 seconds
International Normalized Ratio (INR) 1.1 0.8-1.2
Activated Partial Thromboplastin Time (aPTT) 30 seconds 30-40 seconds

Urinalysis

Test Result Reference Range
Urine Color Dark yellow Pale yellow
Specific Gravity 1.020 1.005-1.030
pH 6.0 4.5-8.0
Protein 2+ Negative
Blood Trace Negative
Glucose Negative Negative
Ketones Negative Negative

Renal Ultrasound

Findings:

  • Bilateral renal enlargement with increased echogenicity, consistent with acute renal failure.
  • No evidence of obstruction or calculi.
  • Mild cortical thinning noted.