Clinical Case Database / Category: Case Based Discussion

Chronic kidney disease and its complications

Publication details

Dr S Gopaluni, Dr R Baker
Foundation Years Journal, volume 2, issue 10, p.431 (123Doc Education, London, December 2008)


A 59-year-old Afro-Caribbean gentleman presented with a 3-month history of gradually worsening tiredness, breathlessness, sickness and itching. Five-years ago he was found to be hypertensive by his GP and was given lifestyle modification advice but was lost to follow-up. He was a smoker with a 40-pack-year history. On admission his BP was high at 180/100. ECG showed a left ventricular strain pattern. The chest X-ray was reported as showing mild cardiomegaly. Urine dipstick showed 2 protein. Lab tests revealed sodium 136 mmol/L, potassium 4.5 mmol/L, urea 40.1 mmol/L, creatinine 830mmol/L, haemoglobin 6.6 g/dL, calcium 2.05 mmol/L, phosphate 3.5 mmol/L, and glucose 6.0 mmol/L. An USS of kidneys demonstrated bilaterally small kidneys (bipolar length less than 8 cm with thin cortices) with no evidence of hydronephrosis. He was deemed to have reached end-stage renal disease, the cause of which was uncertain, and he was initiated on haemodialysis.

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Dr S Gopaluni

Specialist Registrar in Renal Medicine
St. James University Hospital
Leeds, UK

Dr R Baker (Corresponding author)

Consultant in Renal Medicine
St. James University Hospital
Leeds, UK


1. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification.
2. CG73 Chronic kidney disease: NICE guideline, available at
3. CG34 Hypertension - NICE guideline, available at


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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