Acute Kidney Injury in a 65-Year-Old
Patient With Nausea and Fatigue /
Comprehensive iHuman Case Study 65-
Year-Old Patient with Nausea and
Fatigue Week 7 Detailed Report
Comprehensive i-Human Case Study: Acute Kidney Injury in a 65-Year-Old Patient With Nausea and
Fatigue
Patient Introduction
• Name: Mr. John Smith (pseudonym)
• Age: 65 years
• Sex: Male
, • Occupation: Retired accountant
• Presentation: Nausea, generalized fatigue, reduced appetite
• Setting: Outpatient clinic with laboratory capabilities
History of Present Illness (HPI)
• Onset: Gradual onset of fatigue over the past 7 days, accompanied by intermittent nausea and
mild anorexia.
• Associated symptoms: Occasional mild confusion, reduced urine output over 2 days, mild lower
extremity swelling.
• Denies: Fever, vomiting, diarrhea, chest pain, shortness of breath, hematuria, dysuria, flank
pain.
• Past episodes: No prior history of kidney disease.
• Medications: Recently started on high-dose NSAIDs for osteoarthritis knee pain.
• Past medical history: Hypertension (on lisinopril), Type 2 diabetes mellitus (well-controlled on
metformin), hyperlipidemia.
• Surgical history: Appendectomy in 40s.
• Allergies: NKDA.
• Social history: Retired, lives with spouse, no tobacco or illicit drug use, occasional alcohol.
• Family history: Father had CKD secondary to hypertension.
Review of Systems (ROS)
• General: Fatigue, malaise, mild weight loss (~2 kg in 2 weeks)
• Cardiovascular: No chest pain, palpitations, or edema apart from mild ankle swelling
• Respiratory: No dyspnea or cough
• Gastrointestinal: Nausea, decreased appetite, no vomiting, constipation
• Genitourinary: Oliguria for 2 days, no hematuria, no dysuria
• Musculoskeletal: Mild knee pain from osteoarthritis
• Neurological: Mild confusion, otherwise intact
• Skin: No rashes
• Endocrine: No polyuria or polydipsia
, Physical Examination
• Vitals: BP 150/88 mmHg, HR 88 bpm, Temp 36.8°C, RR 18/min, SpO₂ 96% RA
• General: Alert but mildly lethargic
• Skin: Mild pallor, no jaundice, mild peripheral edema
• HEENT: No oral ulcers, no scleral icterus
• Cardiovascular: Regular rate and rhythm, no murmurs, mild ankle edema
• Respiratory: Clear breath sounds bilaterally
• Abdomen: Soft, non-tender, no organomegaly
• Neurological: Oriented to person and place, mild inattention
• Extremities: Mild bilateral pitting edema at ankles
• Other: No costovertebral angle tenderness
Differential Diagnosis Table
Condition Supporting Evidence Against / Notes
Acute Kidney Injury (pre-renal, Oliguria, fatigue, mild confusion, NSAID Needs labs & imaging to
intrinsic, post-renal) use, hypertension, diabetes, edema classify type
Dehydration / Volume No vomiting/diarrhea,
Mild hypotension, NSAID use
depletion adequate intake
Chronic Kidney Disease No known prior CKD, recent
Age, diabetes, hypertension
exacerbation onset
Hepatic disease Mild confusion, anorexia No jaundice, labs needed
Electrolyte disturbance
Fatigue, nausea, mild confusion Labs required
(hyperkalemia)
Heart failure exacerbation Mild edema, fatigue No dyspnea, clear lungs
Diagnostic Workup Strategy
Patient With Nausea and Fatigue /
Comprehensive iHuman Case Study 65-
Year-Old Patient with Nausea and
Fatigue Week 7 Detailed Report
Comprehensive i-Human Case Study: Acute Kidney Injury in a 65-Year-Old Patient With Nausea and
Fatigue
Patient Introduction
• Name: Mr. John Smith (pseudonym)
• Age: 65 years
• Sex: Male
, • Occupation: Retired accountant
• Presentation: Nausea, generalized fatigue, reduced appetite
• Setting: Outpatient clinic with laboratory capabilities
History of Present Illness (HPI)
• Onset: Gradual onset of fatigue over the past 7 days, accompanied by intermittent nausea and
mild anorexia.
• Associated symptoms: Occasional mild confusion, reduced urine output over 2 days, mild lower
extremity swelling.
• Denies: Fever, vomiting, diarrhea, chest pain, shortness of breath, hematuria, dysuria, flank
pain.
• Past episodes: No prior history of kidney disease.
• Medications: Recently started on high-dose NSAIDs for osteoarthritis knee pain.
• Past medical history: Hypertension (on lisinopril), Type 2 diabetes mellitus (well-controlled on
metformin), hyperlipidemia.
• Surgical history: Appendectomy in 40s.
• Allergies: NKDA.
• Social history: Retired, lives with spouse, no tobacco or illicit drug use, occasional alcohol.
• Family history: Father had CKD secondary to hypertension.
Review of Systems (ROS)
• General: Fatigue, malaise, mild weight loss (~2 kg in 2 weeks)
• Cardiovascular: No chest pain, palpitations, or edema apart from mild ankle swelling
• Respiratory: No dyspnea or cough
• Gastrointestinal: Nausea, decreased appetite, no vomiting, constipation
• Genitourinary: Oliguria for 2 days, no hematuria, no dysuria
• Musculoskeletal: Mild knee pain from osteoarthritis
• Neurological: Mild confusion, otherwise intact
• Skin: No rashes
• Endocrine: No polyuria or polydipsia
, Physical Examination
• Vitals: BP 150/88 mmHg, HR 88 bpm, Temp 36.8°C, RR 18/min, SpO₂ 96% RA
• General: Alert but mildly lethargic
• Skin: Mild pallor, no jaundice, mild peripheral edema
• HEENT: No oral ulcers, no scleral icterus
• Cardiovascular: Regular rate and rhythm, no murmurs, mild ankle edema
• Respiratory: Clear breath sounds bilaterally
• Abdomen: Soft, non-tender, no organomegaly
• Neurological: Oriented to person and place, mild inattention
• Extremities: Mild bilateral pitting edema at ankles
• Other: No costovertebral angle tenderness
Differential Diagnosis Table
Condition Supporting Evidence Against / Notes
Acute Kidney Injury (pre-renal, Oliguria, fatigue, mild confusion, NSAID Needs labs & imaging to
intrinsic, post-renal) use, hypertension, diabetes, edema classify type
Dehydration / Volume No vomiting/diarrhea,
Mild hypotension, NSAID use
depletion adequate intake
Chronic Kidney Disease No known prior CKD, recent
Age, diabetes, hypertension
exacerbation onset
Hepatic disease Mild confusion, anorexia No jaundice, labs needed
Electrolyte disturbance
Fatigue, nausea, mild confusion Labs required
(hyperkalemia)
Heart failure exacerbation Mild edema, fatigue No dyspnea, clear lungs
Diagnostic Workup Strategy
