A 41-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated serum creatinine level. Six days earlier, he had had chills and malaise and had taken ibuprofen. Symptoms persisted, and weakness, abdominal pain, nausea, and anorexia developed. He went to an emergency room, where elevated serum creatinine and urea nitrogen levels were noted. The urinary sediment contained granular casts.
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