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:
- What do the lab results suggest?
- What should you do next?
- Want a 1-minute consult/tutorial on this case?
- Want to know what happened with this patient?
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ANSWERS:
- What do the lab results suggest? Post-renal v. intrinsic renal failure.
- 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!!!
- Want a 1-minute consult/tutorial on this case? See yellow area from sample page below.
- 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
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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:
- Never
- Always