A rare report of obstructive nephropathy induced hyponatremia.

Hyponatremia is a common finding in patients admitted to hospitals in the USA. There is a plethora of causes ranging from excessive diuretic use to volume overload from underlying heart failure or liver cirrhosis. The consequences of missing or mistreating the aforementioned diagnosis can lead to catastrophic outcomes. Here, we focus on a rare yet overlooked cause of hyponatremia: obstructive nephropathy. The causes of obstructive nephropathy in elderly patients are broad with neurogenic bladder being one of the common ones. Our patient is an elderly male who presented with hyponatremia in setting of urine retention post an orthopedic surgery.

A Case of Pyelonephritis in an Anuric Patient with End-Stage Renal Disease on Hemodialysis.

Urinary tract infections are common sources of infections requiring antibiotic use worldwide. Chronic kidney disease (CKD) patients, especially those with minimal urine output are challenging when it comes to antibiotic stewardship given the scarcity of cases in the literature. It is further complicated by the fact that end-stage renal disease (ESRD) patients are found to have asymptomatic pyuria and its clinical significance for bacterial infection is yet to be determined. In this case, we report a patient who presented with non-specific symptoms including fever, cough, chills, diarrhea, nausea and was found to have left-sided perinephric stranding on CT scan of the abdomen. The patient also had a fever of 104.6 F which we attributed to left-sided pyelonephritis given the high sensitivity of such findings on CT scan. In this report, we explored the literature for the incidence and management of pyelonephritis in ESRD patients who are anuric.

Acute Renal Failure in a Patient With Severe Acute Respiratory Syndrome Coronavirus 2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious viral pathogen with high morbidity and mortality rate. The infection affects multiple organ systems leading to systemic organ failure. There is an increased incidence of acute kidney injury (AKI) in patients who become critically ill. In the critical care setting, the incidence of AKI has been variable amongst different studies. Patients with acute kidney injury who progress to renal replacement therapy are associated with worse outcomes. We describe a case of a 42-year-old male who presented with hypoxemic respiratory failure secondary to SARS-CoV-2 associated pneumonia. The patient was initially managed with the nasal cannula and then required high flow nasal cannula with worsening hypoxemic respiratory failure, requiring invasive mechanical ventilation. On top of worsening respiratory status, the patient developed new onset renal failure requiring hemodialysis.

Atazanavir-Associated Crystalline Nephropathy.

Crystalline nephropathy can occur following treatment with multiple therapeutic agents. We describe a human immunodeficiency virus (HIV)-infected patient treated for 2 years with combination antiretroviral therapy including atazanavir (ATV). Kidney biopsy revealed a crystalline nephropathy associated with diffuse chronic and granulomatous interstitial inflammation. Following the biopsy, treatment with ATV was discontinued and kidney function returned to pretreatment baseline levels. ATV, which has a well-established association with nephrolithiasis, is a rare but important cause of crystalline nephropathy. Recognition of this association and prompt withdrawal of the offending agent are critical to optimize outcomes.