You are called by the surgical intern to see a 68 yr old
man in the surgical ICU because of new onset azotemia.
He has a history of smoking, hypertension, and peripheral vascular disease, and
was admitted 3 days earlier for unstable angina.
His chest pain was refractory to maximal medical therapy, so he underwent cardiac cath, and subsequently 3 vessel coronary bypass grafting 48 hours prior to your call from the intern.