Images in Nephrology (Section Editor: G. H. Neild) Urine spoke well before the patient

hypertension and depressive disorder was hospitalized due to unexplained severe inebriation followed by sedation. Regular medications consisted of metformin 1500 mg, enalapril 20 mg and paroxetine 20 mg. Blood tests showed a creatinine of 0.9 mg/dL (79 lmol/L), glucose 110mg/dL (6.1mmol/L) and potassium 6.4 mmol/L. Blood gas test showed a pronounced metabolic acidosis, with pH 7.04, bicarbonate 3 mmol/L, PCO2 10 mmHg, lactic acid 4.8 mmol/L, Na 145 mmol/L, chloride 105.4 mmol/L and anion gap 43 mmol/L. Cerebrospinal fluid analysis and cerebral computerized tomography scan were normal. The patient’s condition, including cognitive status, was rapidly deteriorating, requiring orotracheal intubation. Anuria developed in the following few hours, requiring the referra