Caso Clinico Renal

A 47-year-old white female developed severe nausea and vomiting 4 weeks prior to her current hospital admission. There had been no pain, but she had experienced a 3.2-kg weight loss. Her serumurea nitrogen was 40 mg/dL and her creatinine 3.2 mg/dL. Urinalysis revealed numerous erythrocytes and granular casts, but an intravenous pyelogram (IVP) showed no structural abnormalities orobstruction. Five days later the creatinine rose to 6.8 mg/dL, the serum urea nitrogen rose to 72 mg/dL and the creatinine clearance was 13 mL/min (reference range, 72–114). Past history wasunrevealing, and there were no abnormal physical findings.
The patient was referred to the university hospital because of the significant deterioration of renal function. On admission thepatient had the following laboratory findings:

|Analyte |Value |
|Hemoglobin|11.0 g/dL (12–16) |
|Creatinine |6.3 mg/dL (0.7–1.2)|
|Urea nitrogen |70 mg/dL (7–18) ||Sodium |135 mmol/L (136–145) |
|Potassium |4.6 mmol/L (3.8–5.1)|
|Chloride |97 mmol/L (98–108)|
|CO2total |21 mmol/L (23–29) |
|Urinalysis |...