Abstract

We present a case of a 41-year-old woman with a history of hypertension and recent NSAID use, who developed acute kidney injury (AKI) on top of chronic kidney disease (CKD), (that is not recognized previously) , normocytic anemia, and suspected heart failure. The case highlights the potential risks of NSAID use in patients with underlying renal disease and the need for early recognition and intervention. Anemia complication on heart , fever can indicate serious  undergoing disease ,  case found to be severe rheumatoid heart disease complicated by endocarditis and  highly mobile valve vegetation.