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JAMA Clinical Challenge
April 11, 2017

Acute Anuric Renal Failure in an 80-Year-Old Man

Author Affiliations
  • 1Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
  • 2Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
JAMA. 2017;317(14):1471-1472. doi:10.1001/jama.2017.0704

An 80-year-old man with a history of hypertension, gastroesophageal reflux disease, and stage 4 chronic kidney disease presented with 2 days of anuria. He felt well until 6 days prior, when he awoke with diffuse muscle cramps following a strenuous day of moving boxes. He subsequently developed oliguria that progressed to anuria. His only medication was omeprazole (20 mg daily). His usual fluid intake had not changed.

Physical examination was notable for moist mucous membranes, clear lungs, no lower extremity or periorbital edema, and no jugular venous distension. Examination was otherwise unremarkable. Bladder scan showed 50 mL of urine, which was collected via straight catheterization. Three liters of normal saline was administered, with no further urine production.