A 45-year-old female patient complains of nausea,vomiting,fatigue,and weakness.She admits to a history of heroin abuse for 11 years.She quit using the drug after rehabilitation last year and denies current use of the drug.Habits include use of alcohol daily,4-5 "drinks a day," and tobacco use of 60-pack years.On physical examination,she is non-febrile,has a blood pressure of 148/98,pulse 78,and resps 16/min.The patient has periorbital edema.Lungs are clear to auscultation.Abdomen is non-tender and distended w/ mild hepatomegaly.No neurologic deficits.Laboratory testing reveals Hgb 10,BUN of 60,potassium 6.1,and serum creatinine 2.9 mg/dL.These findings are characteristic of:

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The patient's history of heroin abuse and current alcohol use suggest possible drug-induced kidney damage. The elevated BUN and creatinine levels indicate impaired kidney function, and the high potassium level is also consistent with kidney dysfunction. The mild hepatomegaly and periorbital edema may also be signs of renal failure. Dehydration and congestive heart failure may cause similar symptoms, but the patient's history and laboratory results make chronic renal failure the most likely diagnosis. Liver failure may also cause elevated BUN and creatinine levels, but the absence of other liver function abnormalities and the presence of hepatomegaly suggest that kidney damage is the primary problem.

A 45-Year-Old Female Patient Complains of Nausea,vomiting,fatigue,and Weakness