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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M6_F2.jpg"}},{"insert":"\n\n"},{"insert":"You are introduced to Mr. Sato, a 76 year old retired engineer.\n\nSince waking up today, he has been mildly dyspneic; this has gradually worsened over the last several hours.\n\nHe was diagnosed with hypertension and chronic kidney disease (CKD) of unknown etiology 12 years ago, and is currently in CKD stage IV.\n\nHis last visit to the renal clinic was just one week ago.\n\nAt that time, his blood pressure was stable at 130\/80 mmHg, while his serum creatinine was 4.0 mg\/dL, giving an estimated glomerular filtration rate (eGFR) of 14 ml\/min\/1.73 m2.\n\nHe has not required dialysis so far, and there is no history of cardiac disease.\n\nOn examination, his pulse is 80 bpm, blood pressure is 160\/70 mmHg, and respiratory rate is 24\/min. There is no peripheral edema.\n\nHe is markedly dyspneic, and using the accessory muscles of respiration. Auscultation reveals fine crackles over both lung fields.\n\nThe remainder of the examination is unremarkable.\n"}]}