Page 1 of 1: Nephrology clinical question

legolassildarin · Credits: 2418 My Scrapbook My Reading List 19 Books

a 76 yr old male patient presents to the emergency room.he had influenza and now presents with diffuse muscle pain and weakness.his past medical history is remarkable for osteoarthritis, foer which he takes ibuprofen.physical examination reveals a blood pressure of 130/90 with no orthostatic change.the only other finding is diffuse muscle tenderness.
lab data includes: -
BUN : 30 mg/dl
Creatinine : 6 mg/dl
K : 6.0 mEq/L
Uric acid : 18 mg/dl
Ca : 6.5 mg/dl
P O4 : 7.5 mg/dl
CPK : 28,000 IU/L
urine output : 40ml/hr

Q1.Which is the most likely diagnosis?
a. NSAID induced ARF
b.Volume Depletion
c.Rhabdomyolysis induced ARF
d.Urinary tract obstruction

Q2.Which diagnostic test is most useful for the patient?
a.Urine Sodium
b.Urinalysis
c.Renal Ultrasound
d.Urine uric acid-urine creatinine ratio

do reply
ciao

drlouis · Credits: 5374 My Scrapbook

Q1.Which is the most likely diagnosis?
a. NSAID induced ARF
b.Volume Depletion
c.Rhabdomyolysis induced ARF
d.Urinary tract obstruction

answer : c Rhabdomyolysis induced ARF -

Q2.Which diagnostic test is most useful for the patient?
a.Urine Sodium
b.Urinalysis
c.Renal Ultrasound
d.Urine uric acid-urine creatinine ratio

answer :b.Urinalysis ( look for urine myoglobinuria by spectrophotometry)

we recently came across two pt with acute myositis with elevated and who subsequently went in to ARF because of myoglobinuria and which should have been prevented with adeuate hydration to flush away all the pigments ( u need to maintain the urine output to around 300 ml/hr to prevent this complication that can cause death.

ratnakar_potla · Credits: 5713 My Scrapbook My Reading List 2 Books

agree with louis.......... but if the same patient is a known diabetic?

legolassildarin · Credits: 2418 My Scrapbook My Reading List 19 Books

hi dr.louis,
actually even i've seen a patient like this.he presented with cellulitis of abdominal wall and died in 2hrs.the diagnosis was skeptical for sometime but he was finally diagnosed by the medicine HOD as a case of rhabdomyolysis induced ARF.
thanx for replying
bye

drlouis · Credits: 5374 My Scrapbook

if the pt is diabetic-- he is most likely to have diabetic myonecrosis

if the pt has cancer- he is likely to have tumor lysis syndrome

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