Renal & Urinary System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M24_F1.jpg"}},{"insert":"\n\n"},{"insert":"You wake up on a bright, warm Sunday, feeling refreshed, and quickly get dressed for your shift at the ER.\r\n\r\nThe weather looks great as you make your way to the hospital, wondering what\u0027s in store for you today.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M24_F2.jpg"}},{"insert":"\n\n"},{"insert":"As you step in through the ER doors, you notice a middle-aged caucasian man walking in somewhat effortfully a few paces behind you.\r\n\r\nThus, you are unsurprised when a short while later, the nurse gestures towards him as your first patient of the day, handing you his file.\r\n\r\n\u0022How can I help you, Mr. Brown?\u0022 you ask cordially, reading his information.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M24_F3.jpg"}},{"insert":"\n\n"},{"insert":"Mr. George Brown is a 53-year-old caucasian male. He was diagnosed with benign prostatic hyperplasia two months ago but is otherwise healthy.\r\n \r\nHe refused treatment at that time as he was able to perform his usual daily activities without much trouble.\r\n\r\nAs you request for him to have a seat, you notice that he doesn\u0027t look very well at all today.\n"}]}


{"ops":[{"insert":"\u0022My stomach really hurts and I feel like throwing up,\u0022 he says effortfully.\r\n \r\n\u0022I haven\u0027t been able to urinate at all this morning.\u0022\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M24_F5.jpg"}},{"insert":"\n\n"},{"insert":"\u0022When did you urinate last?\u0022 you inquire. \r\n\r\n\u0022Around 10 o\u0027clock last night,\u0022 comes the brief, pained response. Your eyes dart to the clock; it\u0027s been nearly 12 hours.\n\nA quick physical examination reveals Mr. Brown to be well hydrated with adequate skin tone and temperature. He weighs 63kg. \r\n \r\nHe has a heart rate of 94 beats per minute, a respiratory rate of 18 cycles per minute and a blood pressure of 140\/90 mmHg. His temperature is 99\u02daF (37.2\u02daC).\n\nAn abdominal exam reveals flank tenderness with an undistended bladder. His prostate is mildly enlarged on a per rectal examination. \r\n \r\nExamination of the remaining systems reveals no abnormalities.\n"}]}


{"ops":[{"insert":"You initiate appropriate pain management and insert a catheter to gauge his urine output, which passes without much resistance. Around 50 mL of urine mixed with blood flows into the bag.\r\n\r\nYou collect samples for a urinalysis and draw blood for routine tests including renal functions. You also order a renal ultrasound.\n\nA quick glance at Mr. Brown\u0027s file tells you that at the time that he was diagnosed with benign prostatic hyperplasia, his creatinine levels were normal, at 1.0 mg\/dL.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M24_F7.jpg"}},{"insert":"\n\n"},{"insert":"A short while later, the nurse on duty calls your attention to his investigation results:\r\n\r\nWBC: 8.2 x 10^9 \/L (3.5 - 11)\r\nRBC: 5.0 x 10^12 cells\/L (4.32 - 5.72)\r\nMCV: 90 fL (80 - 100)\r\nMCH: 29 pg (27 - 31)\r\nMCHC: 35 g\/dL (32 - 36)\r\nHct: 42% (38 - 50)\r\nHb: 16.3 g\/dL (14 - 17.5)\r\nPLT: 300,000\/mm3 (150,000 - 450,000)\n\nSodium (Na+): 139 mmol\/L (135-145)\r\nPotassium (K+): 4.1 mmol\/L (3.5-5)\r\nChloride: 100 mmol\/L (95-105)\r\nCopper: 72 \u00b5g\/dL (70-150) \r\nInorganic phosphorous: 1.2 mmol\/L (1-1.5) \r\nPhosphate: 1 mmol\/L (0.8-1.5) \r\nTotal calcium: 2.4 mmol\/L (2-2.6) \r\nIonized calcium: 1.06 mmol\/L (1.03-1.23) \r\nMagnesium: 1.9 mEq\/L (1.5-2)\r\nBUN: 15 mg\/dL (7 - 20)\r\nSCr: 3.6 mg\/dL (0.6 - 1.1)\n\nThe urinalysis is as follows:\r\nColor and turbidity: Dark and cloudy\r\npH: 5.0 (5.5-6.5)\r\nSpecific gravity: 1035 (1010-1025)\r\nGlucose, Ketones, Nitrites, Leukocyte esterase, Bilirubin: Negative\r\nUrobilirubin: Small amounts \r\nProtein: +\r\nRBCs: 52 RBCs\/HPF (0-4)\r\nWBCs: 5 WBCs\/HPF (0-5)\r\nSquamous epithelial cells: 14 squamous epithelial cells\/HPF (0-20)\r\nCasts: Granular casts \r\nCrystals: Needle shaped crystals\r\nBacteria, Yeast: None\n\nThe renal ultrasound scan shows structurally normal kidneys, ureters, and bladder.\r\n\r\n\u0022What could this be, doctor?\u0022, a new and rather eager nurse asks.\n"}]}