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    Class Notes - Rads

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    imran
    A 26-year-old female presented with fever, back pain, and urinary symptoms. She reported a history of urinary issues and taking over-the-counter medications. On exam, she had a fever, tachycardia, elevated creatinine and BUN, and a urinalysis showed brown urine, nitrites, leukocyte esterase, and too numerous to count white and red blood cells. A renal ultrasound found the right kidney to be atrophic and the left kidney edematous.

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    Class Notes - Rads

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    imran
    27 views3 pages
    A 26-year-old female presented with fever, back pain, and urinary symptoms. She reported a history of urinary issues and taking over-the-counter medications. On exam, she had a fever, tachycardia, elevated creatinine and BUN, and a urinalysis showed brown urine, nitrites, leukocyte esterase, and too numerous to count white and red blood cells. A renal ultrasound found the right kidney to be atrophic and the left kidney edematous.

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    Class Notes - Prostate

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    A 26-year-old female presented with fever, back pain, and urinary symptoms. She reported a history of urinary issues and taking over-the-counter medications. On exam, she had a fever, tachycardia, elevated creatinine and BUN, and a urinalysis showed brown urine, nitrites, leukocyte esterase, and too numerous to count white and red blood cells. A renal ultrasound found the right kidney to be atrophic and the left kidney edematous.

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    27 views3 pages

    Class Notes - Rads

    Uploaded by

    imran
    A 26-year-old female presented with fever, back pain, and urinary symptoms. She reported a history of urinary issues and taking over-the-counter medications. On exam, she had a fever, tachycardia, elevated creatinine and BUN, and a urinalysis showed brown urine, nitrites, leukocyte esterase, and too numerous to count white and red blood cells. A renal ultrasound found the right kidney to be atrophic and the left kidney edematous.

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    of 3

    PCM CIS: Case1             RENAL SECTION                        

     
    CC:   Back Pain and fever 
     
    HPI:  26 y/o female is brought to the ER by her husband for increasing fever over the past 24 hrs.  He states that 
    she  thought  she  had  a  bladder  infection  about  a  week  ago,  and  started  forcing  fluids.    Three  days  ago,  she 
    developed a fever of 101.2.  She was not able to seek care since she was travelling back from a mission trip to 
    Kosovo.  Tylenol helped the fever improve. Once back at home (2 days ago), she continued fluids and Tylenol, 
    drank large amounts of  cranberry juice, and rested.  She also took an OTC (Over‐The‐Counter)  medication for 
    urinary symptoms, but doesn’t know what’s in it.  Her husband reports that yesterday, she mentioned that she 
    was not voiding (aka urinating) as much as usual and her mouth was dry.  Though she tried to replenish fluids by 
    mouth, she wasn’t able to keep anything down.  Last night she developed generalized back pain, more severe on 
    the left, and fever returned.  Her husband brought her in this morning, worried that she might need IV fluids or 
    something. 
     
    PMH:  Asthma, exercise induced.  Uses inhaler less than 3 times per week 
     
    PSH:    Appy (Appendectomy) age 10 
     
    GYN:  G0P0, menarche age 12, menses regular with no excessive bleeding every 28 days, LMP (Last Menstrual 
    Period) – 10 days prior to presentation, lasted 5 days 
     
    FH:    Mother died in auto accident 3 years ago, previously healthy.  Father, 24 y/o brother and 18 y/o sister all 
    in good health 
     
    SH:   Married 3 years, monogamous, no TOB, rare ETOH, no recreational drugs.  In graduate school for a PhD 
    in Sociology.  3 y/o Labrador, no other pets, no exposures to toxins or chemicals 
     
    Medications:  Mirena IUD inserted 2 yrs ago (IntraUterine Device) for contraception, multivitamin daily. No 
    other regular OTC or herbals. 
     
    Allergies:  Penicillin causes hives 
     
    ROS:  Other than HPI 
    GEN:   Weak, generalized aches 
    HEENT:  No history of trauma, no headaches, no hearing or vision changes, no nasal drainage or sore throat 
    CV:  No chest pain or palpitations 
    GI:  See HPI.  No reflux, hematochezia or melena 
    GU:  See HPI, urine dark, cloudy, foul odor 
    HEME/LYMPH:  No bleeding or easy bruising   
    ENDO:  No polyuria, polydipsia, weight changes, or hot/cold intolerance 
    SKIN:  No rashes, hair or nail changes 
     
    Physical Exam: 
    Vitals: T:  101.8oF     HR: 120         RR: 26      BP:  90/50     Ht: 5’4”     Wt: 140 lbs    O2Sat:  94% on RA 
    GEN: Awake, alert and oriented X 4 
    HEENT: NC/AT, PERRLA, EOMI, TM’s intact bilaterally ‐ no air/fluid level, Nose – no deviation, mucosa dry, Throat 
    – negative for erythema or exudates, Neck – no lymphadenopathy or thyromegaly 
    Heart: RRR, no murmurs 
    Lungs: CTAB 

     
    RENAL CASE 1 Page 1

    Abd:   Soft, generalized mild tenderness to palpation, non‐distended, no organomegaly, bowel sounds normo‐
    active 
    GU:  Positive CVA (Costovertebral Angle) tenderness on left 
    Skin: Warm, dry, poor tissue turgor 
    Extremities: Moving all four extremities without difficulty; 2/4 carotid, radial, femoral and pedal pulses palpated 
    bilaterally 
    OSE: T12‐L2 NRLSR  
     
     
    Stat CBC  
    WBC  15.2  3.8‐11.0 (103/mm3) 
    HGB  12  12‐16 g/dL 
    HCT  37  37‐54% 
    PLATELETS  520,000  140,000‐450,000 /(mm3) 
       
    Stat Chemistry 
    Albumin  3.5  3.5‐5.0 g/dL 
    Alkaline phosphatase  50  32‐110 U/L 
    ALT  28  8‐32 U/L 
    AST  20  6‐21 U/L 
    Total bilirubin  0.8  0.2‐1.4 mg/dL 
    Calcium  9.3  8‐11 mg/dL 
    CO2  30  21‐34 mEq/L 
    Chloride  110  96‐112 mEq/L 
    Creatinine  3.0  0.6‐1.5 mg/dL 
    BUN  85  8‐25 mg/dL 
    Glucose  108  70‐110 mg/dL 
    Potassium  5.7  3.5‐5.5 mEq/L 
    Sodium  146  135‐148 mEq/L 
    Anion gap  6  5‐16 mEq/L 
     
     
    UA 

    Color  Brown  Straw 


    Specific gravity  1.030  1.003‐1.040 
    pH  5.0  4.6‐8.0 
    Glucose  Negative  Negative 
    Ketones  1+  Negative 
    Albumin  Negative  Negative 
    Nitrites  4+  Negative 
    Leukocyte esterase  4+  Negative 
    Blood  1 +  Negative 
    RBC’s  10  1‐2 cells/hpf 
    WBC’s  TNTC (Too numerous to count)  1‐2 cells/hpf 
    Casts  Negative  Negative 
    Bacteria  TNTC  Negative 
     
     
     
    RENAL CASE 1 Page 2

    Renal Ultrasound 
    Right kidney atrophic, below is left kidney 

    Decreased density —>


    Edema due to Inflammation

     
    RENAL CASE 1 Page 3

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