Alan Smith
Age: 69
Sex: Male
Mr Smith is asked to provide a sample of urine but can only manage a dribble. (“Typical,” he says, “Passing urine all the time, then when I have to do it I can’t!”)
You request a number of investigations, and the results are as follows:
Urinalysis:
- Blood negative
- Protein negative
- Nitrites negative
- Glucose negative
- Ketones negative
- pH 5.0
Arterial Blood Gas:
- pH 7.33
- pO2 11.1
- pCO2 3.4
- HCO3 15
- Base excess -6
- Lactate 1.0
Bloods:
- WCC 7.5
- Neut 6.8
- Hb 136
- MCV 90
- PLT 282
Renal function blood tests:
- Sodium 139 mmol/L
- Potassium 6.2 mmol/L
- Urea is 22.9 mmol/L
- Creatinine 440 µmol/L
Other tests:
- CRP <2
- Liver function studies – normal
- CXR normal
- ECG normal
Scans:
Renal tract and Bladder USS – Bilateral hydronephrosis, with dilation of both ureters. A distended bladder containing >1L urine.
Ultrasound scan of Mr Smith’s right kidney:
Ultrasound scan of a normal kidney for comparison:
