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Clinical History lower extremity swelling. Other complaints unlabored; pulse, 91 bpm; and, blood pressure,
Patient: 53-year-old African-American male included blurred vision, diarrhea, and extreme 177/80 mmHg. Pertinent physical examination
weakness. findings were significant for lower extremity
Chief Complaint: Shortness of breath, lower edema up to the knees, and the presence of
extremity swelling, nausea, vomiting, diarrhea, Past Medical and Surgical History: Type II fine white crystals distributed in patches on the
altered taste sensation, and decreased urine diabetes mellitus and hypertension for about head and neck (Image 1).
output. 10 years. No significant surgical history.
Principal Laboratory Findings: Table 1.
History of Present Illness: Patient presented Social History: No tobacco use, occasional
to the emergency room (ER) with complaints of alcohol use, and no IV drug abuse. Keywords: blood urea nitrogen, uremia,
nausea and vomiting for 2 months, shortness uremic frost
of breath for the last few days, altered taste Physical Exam Vital Signs: Temperature,
sensation, and worsening of preexisting 97.7°F; respiratory rate, 20/minute and
A B
seborrhoeic dermatitis, fungal infection, etc). After scrap- 1. CKD Stages. Available at www.renal.org/whatwedo/InformationResources/
ing crystals from our patient’s skin and dissolving them in CKDeGUIDE/CKDstages.aspx. Accessed November 16, 2010.
physiological saline, we assayed this sample and an equiva- 2. Walsh SR, Parada NA. Images in clinical medicine. Uremic frost. N Engl J
lent volume of saline blank for BUN. The BUN levels in the Med. 2005;352:e13.
saline sample containing the skin scrapings and the saline 3. Pol-Rodriguez MM, Wanner M, Bhat P, et al. Uremic frost in a critically ill
patient. Kidney Int. 2008;73:790.
blank were 24 mg/dL and undetectable, respectively. It has
been estimated that an average resting male with a BUN of 4. Mickelsen O, Keys A. The composition of sweat, with special reference to
the vitamins. J Biol Chem. 1943;149:479-490.
18 mg/dL has a sweat urea concentration of approximately
67 mg/dL.4
Table 1_Principal Laboratory Findings Table 2_eGFR Values Associated With Various Stages
of CKD1
Test Patient’s Result Reference Interval
Hematology CKD
Stage eGFR, mL/min/1.73 m2 Interpretation
WBC count 11.5 4.5-11.0 × 109/L
RBC count 2.83 3.80-5.40 × 1012/L 1 ≥90 with CKD risk factorsa Increased risk for CKD
Hemoglobin 7.9 12.0-16.0 g/dL ≥90 Normal kidney function but urine findings
Hematocrit 23.7 37-47% or structural abnormalities may
Platelet count 299 150-450 × 109/L suggest kidney disease
Chemistry 2 60-89 Mildly reduced kidney function, which
Sodium 138 136-145 mEq/L may suggest kidney disease
Potassium 4.9 3.6-5.0 mEq/L
Chloride 112 98-107 mEq/L 3 30-59 Moderately reduced kidney function
CO2 5 22-30 mEq/L 4 15-29 Severely reduced kidney function
Albumin 3.2 3.2-5.5 g/dL 5 <15 (or patient on dialysis) Very severe or endstage kidney failureb
BUN 132 6-20 mg/dL aRisk factors include, but are not limited to: family history of CKD, hypertension, diabetes,
Creatinine 21.8 0.5-1.2 mg/dL
autoimmune diseases, systemic infections, urinary tract infections, urinary stones, neopla-
eGFR 3 >60 mL/min/1.73 m2 sia, and exposure to certain drugs.
bAlso known as “established renal failure.”
BUN, blood urea nitrogen; eGFR, estimated glomerular filtration rate (MDRD equation);
MDRD, modification of diet in renal disease. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.