Altered Mental Status and Renal Failure in a 58-Year-Old Woman

Abstract

Patient: A 58-year-old Caucasian female Chief Complaint: Altered mental status, fever. Also complains of occipital headache and neck pain. History of Present Illness: Patient had presented to the emergency department 11 days previously with intermittent altered mental status, which was felt to be secondary to hyponatremia caused by treatment for hypertension with a thiazide diuretic. Upon resolution of her hyponatremia, the patient’s altered mentation improved and she was discharged. Her present complaint is an altered mental status that has returned in conjunction with fevers and chills. She presented to the emergency department for further evaluation of a 3-day history of worsening altered mental status, most notably overnight. Past Medical and Surgical History: History of end-stage renal disease secondary to polycystic kidney disease status post renal transplantation in 2005. History of hypertension and hyperlipidemia. Surgical history included a bilateral nephrectomy, renal transplant, and a total abdominal hysterectomy. Family History: Polycystic kidney disease. Social History: Patient admitted to occasional social alcohol intake; denied tobacco and recreational drug use. ### Physical Examination Vital Signs: Temperature, 100.1°F; pulse 93 beats per minute; respiratory rate, 16 breaths per minute; blood pressure, 154/82 mmHg. The patient was a well-nourished Caucasian woman of normal weight. The patient was in mild distress from pain. Principal Laboratory Findings: Table 1 Results of Additional Diagnostic Procedures and Tests CT (head): negative Cultures Lumbar Puncture Kidney, Left, Core Biopsy: Final pathologic diagnosis: marked acute and chronic interstitial and tubular inflammation with focal necrosis consistent with acute pyelonephritis. There appears to be …