Evaluation and Management of Renal and Genitourinary Conditions

Evaluation and Management of Renal and Genitourinary Conditions

Patient is a 70 year old male who presents with to the ED by his primary care physician for further evaluation of creatinine of 3.2 mg/dl following a three day history of nausea and vomiting now with dry heaves, poor oral intake, fatigue, decreased urine volume and orthostatic hypotension (108/60) and tachycardia ( 98bmp). PMH significant for lifting a heavy object resulting in low back pain 1 week prior. He self-medicated with NSAID(BID ). His medication includes lisinopril, metoprolol, and hydrochlorothiazide. His primary diagnosis is also significant for mild chronic renal disease with creatinine (1.1mg/dl ) a month ago with protein urea of 400mg. Physical examination is notable for dry mucus membrane, mild periumbilical tenderness and lack of CVA tenderness or bladder distension.

Differential diagnosis

1. Acute kidney injury secondary to true intravascular volume depletion and medication related side effects.

2. Pre-renal azotemia

3. Intra renal azotemia

4. Urinary obstruction.

Diagnostic test:

CBC, BMP, renal Ultrasound, renal ultrasound.

FYI:

Primary diagnosis is the Acute kidney injury secondary to due intravascular volume depletion and medication related side effects.

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