METHODS
Labs revealed normal electrolytes level with Bicarbonate - 13, Anion Gap-28, BUN- 119, Creatinine - 13.36, Ca- 5.2, Phosphorus- 12.7, with eGFR-4.4. Liver function assays revealed AST-2376, ALT-563, Lipase- 265, Lactic acid- Normal Bilirubin, and ALP- normal. CBC showed mild Leukocytosis with a Hemoglobin of 11.4.
There was an exceptional increase in Creatine Kinase with values of 307, 570 (rechecked by dilution) with ESR-71; CRP-100.40; TSH - normal; Hepatitis Panel was negative Ethanol, Salicylates was negative and urinary drug screen was negative. Urine Analysis showed Glucose- 2+; blood- 3+; protein- 3+; RBC-12; WBC-7. The PTH intact was high- 148 (N-12-88 pg/mL); Calcium- 5.2; ionized calcium- 0.87; Vit D- 7.0.
Non contrast CT Abdomen and pelvis showed loss of cortical medullary differentiation in the kidneys bilaterally no hydronephrosis or nephrolithiasis was appreciated. (Figures 1 and 2)
In the Emergency, foley catheterization was tried 2 times with no urine output. However, a bladder scan showed 125 ml of urine. The patient was anuric despite 5 L of crystalloid resuscitation. The patient was then taken to ICU, temporary catheterization was done and hemodialysis was initiated with a 125 ml/hr of bicarbnonte drip.