In this Discovery Clinical Pathological Conference (CPC), Drs. Nico Herrera and Jefferson Triozzi, Residents, Department of Medicine,  discuss the case of a 47-year old male patient with hypertension, diabetes mellitus, and end-stage renal disease on emergent dialysis who presented with three months of severe headaches, blurry vision, and a recent onset of fever. The patient was negative for HIV and hepatitis. However, his catheter did not show signs of infection. The patient was anemic and had elevated BUN. CT scan of the head without contrast was unremarkable. Dr. Marc Robinson, Assistant Professor, Department of Medicine, Baylor College of Medicine, serves as the faculty discussant. Dr. Robinson outlines the additional laboratory and imaging data that he would request and the clinical problem solving strategies that he would use to arrive at a differential diagnosis in this case. He highlights those items in the patient’s history, symptoms, and test results that are important, and those that can be excluded. He also explains how literature can contribute when making a differential diagnosis.

Expert comments on emergent dialysis, particularly in undocumented immigrants, are given by Dr. Rajeev Raghavan, Associate Professor, Department of Medicine, Section of Nephrology at Baylor College of Medicine.