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Nephrol Dial Transplant (2004) 19: 1925-1927
Nephrol Dial Transplant Vol. 19 No. 7 © ERA-EDTA 2004; all rights reserved

Nephroquiz
(Section Editor: M. G. Zeier)

Hard times with hard water

Ralph Kettritz, Bernhard Pilz and Friedrich C. Luft

Franz Volhard Clinic, HELIOS Klinikum-Berlin, Medical Faculty of the Charité, Humboldt University of Berlin, D-13125 Berlin, Germany,Email: Kettritz@fvk-berlin.de

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Case

A 69-year-old man with known coronary artery disease, atrial fibrillation, peripheral vascular disease and chronic renal insufficiency was admitted to the hospital acutely ill. He had received an angiotensin-converting enzyme inhibitor, a ß-blocker and phenprocuomon. He was dyspnoeic and in acute distress. He had distended neck veins and rales bilaterally. Furthermore, he had pitting oedema of the sole remaining lower extremity. After a brief physical examination and administration of oxygen, morphine and nitroglycerin, laboratory information was available. An electrocardiogram (ECG) was done (Figure 1, left panel). His . . . [Full Text of this Article]

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