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NDT Plus Advance Access published online on November 3, 2009
NDT Plus, doi:10.1093/ndtplus/sfp159
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A pilot in distress

Sophie Bennett, Nicos Mitsides, Ajay Dhaygude and Alexander Woywodt

Renal Unit, Lancashire Teaching Hospitals NHS Trust, Preston, Lancashire, UK

Correspondence: Alexander Woywodt; E-mail: Mail@Alexander-Woywodt.com

Key Words: allopurinol • chronic renal failure • hypersensitivity

Received for publication August 28, 2009. Accepted for publication October 6, 2009.

The first 150 words of the full text of this article appear below.


   Introduction
 
Acute kidney injury in patients with chronic renal failure is a common scenario in clinical practice. In many cases, the cause is obvious, as in urinary tract infection, dehydration, use of non-steroidal anti-inflammatory drugs or recent therapeutic manipulation of the renin–angiotensin–aldosterone system. In some cases, however, the acute element can be more difficult to identify or remain elusive even after commencing dialysis. We present the case of a 77-year-old retired small-aircraft pilot with chronic renal failure, who returned from holidays with an acute, substantial and entirely unexplained deterioration in renal function. It was a tortuous journey, until we finally deciphered the underlying cause and avoided imminent dialysis. We discuss the presumed underlying mechanism and implications for the management of acute kidney injury in patients with pre-existing chronic renal failure.


   Case
 
A 77-year-old man with known chronic renal failure presented unwell and with an acute deterioration of his renal function.

He had . . . [Full Text of this Article]


   Discussion
 

   Conclusion
 

   Teaching points
 

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