Abstract
A 65-YEAR-OLD MAN PRESENTED with a 1-week history of abdominal pain and was noted to have acute kidney failure, with a serum creatinine level of 3.9 mg/dL (343 μmol/L). The patient had experienced multiple hospitalizations in the prior 12 months and had demonstrated chronic kidney disease, with a serum creatinine level in the 2.2- to 2.4-mg/dL (194- to 211-μmol/L) range. A recent prior hospitalization had shown unilateral hydronephrosis with stones on the left, and a bladder catheter had been left in place due to urinary retention. The patient presented this time with a 1-week history of nausea and abdominal pain, and was found to have methicillin-resistant Staphylococcal aureus in his urine and a positive stool result for Helicobacter pylori antigen. He was treated with triple therapy for the H pylori (ampicillin, clarithromycin, and a proton pump inhibitor) and vancomycin for his urinary tract infection, with improvement of his abdominal pain. Due to active urinary sediment with the possibility of white blood cell casts, ampicillin and clarithromycin were stopped after 4 days of therapy, but vancomycin therapy was continued for the urinary tract infection. Although urine examination was subsequently negative for eosinophils, due to concern over possible interstitial nephritis, prednisone, 30 mg twice daily, was initiated.
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