A 44-year-old man, obese, merchant sailor, with sedentary lifestyle.
On vacation, she observed that a child was drowning at sea.
He tried to rescue her with great effort and despair, aspirating and swallowing a lot of water, and almost drowning.
During the following two days she had vomiting, inability to eat, malaise, severe myalgia and decreased urine output.
Located in an emergency department.
He was hypertensive (170/110 mmHg) and had uremic alienation.
The presence of conjunctival petechiae (signo) and tenderness of the limbs and abdominal wall muscles were striking.
The ultrasound showed kidneys of normal size and appearance.
Laboratory tests revealed marked azotemia and elevated muscle enzymes.
Urine test was positive for blood and sediment showed only 2 to 3 erythrocytes per field.
It was managed with volume and parenteral bicarbonate.
The next day, the uremic symptoms intensified and became more common during two consecutive days.
On the fourth day of hospitalization polyuria began with progressive recovery of renal function, reaching a creatinine level of 1.1 mg/dl 20 days after the initial episode referred.
