Case 15-1970

Presentation of Case First admission. A thirty-eight-year-old man was admitted to the hospital because of uremia.At the age of fourteen years he had been studied at another hospital because of "kidney trouble"; an intravenous pyelographic study revealed dilatation of the left collecting system and a calyceal filling defect, and a retrograde pyelographic study demonstrated bilateral ureteral angulations. Subsequently, he failed the Armed Services induction examination because of proteinuria. Eighteen months before entry there was the onset of fatigue, malaise and joint swelling, interpreted by a physician as "gouty arthritis." One year later weakness, pallor, dyspnea and ankle edema . . .