A case of extreme azotaemia

Despite intensive therapy, the mortality rate in acute renal failure still exceeds 30% [1]. Advanced age, multiple organ failure, oliguria and high blood urea nitrogen (BUN) at the time of diagnosis are associated with a poorer prognosis [2]. Rapid diagnosis and prompt treatment are critical to prevent death and irreversible renal failure. Renal biopsy remains the golden standard for diagnosis. Glucocorticoids and cyclophosphamide are the cornerstones in the treatment of rapidly progressive glomerulonephritis; they dramatically ameliorate glomerular injury and induce remission in 75–80% of cases [3]. We present a patient with remarkable biochemical derangement, especially high BUN (Table 1). A case like this has not previously been seen in our department, nor described in the literature.