Dr C. Rollino Nephrology and Dialysis Unit S. G. Bosco Hospital Turin, Italy

 

In December 2002, a 76 year-old man complained of lower limb pain. He was given anti-inflammatory drugs such as nimesulide and piroxicam, which he took once daily. During that period, the results of laboratory investigations showed Serum creatinine 0.9 mg/dl, Hb 13 g/dl, leukocytes 5300/mm3, Erythrocyte Sedimentation Rate 59 mm/h.

He began complaining of fatigue and intermittent fever (about 38°C) at the beginning of January 2003.

At the end of January, he reported to an emergency service and, following evidence of renal failure, was then admitted to a Nephrology Department, with a serum creatinine of 9.1 mg/dl.

Body weight was 73 Kg and Body Mass Index was 24.7 Kg/m 2. Blood pressure was 160/90 mmHg.

Other examinations showed: Hb 8.2 g/dl, leukocytes 26500/mm 3, platelets 344000/mm 3; liver enzymes in normal range; PCR 17.8 mg/dl; proteinuria 0.9 g/day; in the urinary sediment hematuria (30 RBC/hmf) and granular and haematic casts.

Question 1