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Great question, Claudia.
These cases are a great example of having one or two symptoms that tips that scale in favour of another diagnosis.
The first tip-off (that isn’t a symptom) comes our way from the patient’s history. The patient has a history of recreational drug use. We don’t know what drugs were used; however, due to the fact that the patient was diagnosed with acute nephritis we can assume it is one of the harder drugs (cocaine, heroin, meth). Most drugs (even caffeine) cause the body to “burn hot,” and they tend to use Yin as their fuel. The harder drugs contain these toxins.
In terms of symptoms, bleeding and cloudiness really stand out to me. The tongue and pulse show Damp-Heat signs as well.
So, in summary:
Hard drug use + acute nephritis + blood and cloudiness in urine + Damp-Heat signs = Heat-Toxins.