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Acute Renal Failure

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History of Present Illness:

A 62-year-old male presents to the ED for left flank pain and oliguria.    He denies any fever, vomiting, abdominal pain or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for a BP of 160/100  Physical exam is otherwise normal except for mild bilateral flank and lower abdominal tenderness.

Initial Differential Diagnosis:

  • Kidney stone
  • Kidney infection
  • Renal failure
  • Urinary retention
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • CBC: normal except for WBC = 12
  • Chem 7: normal except for bicarb 18, Cr 18.5, BUN 100, K 6.0
  • UA: RBC 140, WBC 10

QUESTIONS:

  1. What do the lab results suggest?
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What do the lab results suggest? Post-renal v. intrinsic renal failure.
  2. What should you do next?  A CT was done for the flank pain showing no stone but bilateral hydronephrosis and a large bladder.  See image below.  A Foley was placed draining 4.2 liters!!!
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

 

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: The patient was admitted and started on an alpha blocker for his prostate.  After 3 days his creatine was 1.3 (his baseline 6 months earlier was 1.1)

CASE LESSONS:

  1. Never
  2. Always
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