Approach to the Patient with Renal Disease

A 35-year-old man presents with a 1-week history of progressive shortness of breath and an episode of hemoptysis earlier today. For the past 2 days he has had decreased urine volume and dark colored urine. He has no past medical history and takes no medications. Blood pressure is 145/85 mmHg. Pulse is 110 beats per minute. Temperature is 36.8 °C. Pulse oximetry is 87 % on room air. He is anxious and slightly pale. Pulmonary exam reveals bibasilar crackles. The remainder of his exam is unremarkable. His laboratory data is notable for a hemoglobin level of 10.9 g/dL and serum creatinine of 2.7 mg/dL. His chest X-ray shows bilateral pulmonary infiltrates.