ELM
Forum Guru
Topics: 28
Posts: 936
|
A 70 y old man is admitted to the hospital because of the acute onset of anuria, nausea, vomiting, and malaise. Resent history remarkable for IVPyelography performed 2 weeks ago and treatment with TCAntidepressants started 1 week ago.Insertion of Foley catheter yields 700ml of concentrrated urine. Lab studies show high urine osmolality and low urine sodium. The most likely cause is
a.Radiographic contrast toxicity
b.Bilateral ureteral stone
c..................
d.Prostate hyperplasia
___________________
ELM
|
| sanz
Forum Elite
Topics: 14
Posts: 154
|
C.
|
| ELM
Forum Guru
Topics: 28
Posts: 936
|
I am sorry i had to change C because it seemed could cause confusion...so please now look at it again!
___________________
ELM
|
| miky
Forum Senior
Topics: 16
Posts: 99
|
D.
___________________
always happy and ready to serve and help my friends and patients as well.
|
| lucky
Forum Guru
Topics: 23
Posts: 505
|
A...
|
| tamriko
Forum Elite
Topics: 23
Posts: 296
|
I think it's A, since he had IVpyelography 2 weeks ago.
|
| ELM
Forum Guru
Topics: 28
Posts: 936
|
All right guys...the answer is D. He is got a postrenal azotemia.....but how can he have high urine osm and low urine sodium? What's in his urine if it's not sodium??? :lol:
___________________
ELM
|
| miky
Forum Senior
Topics: 16
Posts: 99
|
Dear ELM,
I was right, wasn't I?
All right guys...the answer is D. He is got a postrenal azotemia.....but how can he have high urine osm and low urine sodium? What's in his urine if it's not sodium???
That's quite easy: The pt. had severe BPH. He was given iv contrast - cause acute renal failure - tubular nephropathy (pp in the tubular lumen) - could have been avoided if the pt. had been adequately hydrated.
As for high osm - that's aminoacids, not Na. 'Cause of tubular / tubulo-interstitial disease.
Hope I'm right.
___________________
always happy and ready to serve and help my friends and patients as well.
|
| ELM
Forum Guru
Topics: 28
Posts: 936
|
THis patients' post renal azotemia is not from IVP contrast, if it would have happened it develops usually within 24hs after IV radiotrast, not after 2 weeks Miky. Also his urinary retention is exaserbated use of TCA which has Anticholinergic properties---->obstraction--->Anuria. It's not from intrinsic renal damage ie...tubular necrosis.So i am still wondering what's in his urine that elevating the urine osmolarity....we know it's not sodium and now you know it's not aminoacids. :lol:
By the way i never heard there is amino acids in the urine in ATN, you mean protiens....clearify your point please.
Thank you.
___________________
ELM
|
| yutaro
Forum Newbie
Topics: 5
Posts: 21
|
D
raiocontrast damages kidney function acutely.
In 2weeks, it cant be.
Biutrethral stones may cause anuria.
This is my Question. The patient with total gastrectomy recieved abdominal CT Scan with IV contrast.
Seeing the first scan, the radiologist found he had radiocontrast nephrotoxity. How could he discover?
|
| ELM
Forum Guru
Topics: 28
Posts: 936
|
Perhaps patients' status detoriates right away---> goes into acute renal failure or somebody just told the radiologyst that the patient had this happened before or contrast won't go into kidnyes or won't excrete through kidneys ect...goes on ... who knows :lol:.
___________________
ELM
|
| SA
Forum Elite
Topics: 21
Posts: 193
|
ELM explain high osmlality of urine please
___________________
Wish best of luck to all users
|
| yutaro
Forum Newbie
Topics: 5
Posts: 21
|
Now CT scan are well advanced to fully scan patients' abdomen for less than 10seconds. So If delayed scan isn't performed(maybe 1 minute or later), there is no tellting about excretion of radiocontrasts into urethra.
But, Radiocontrasts excrete into gallbradder if patients have acute renal failure.
white gallbradder is a sign.! :roll:
|
| yutaro
Forum Newbie
Topics: 5
Posts: 21
|
|
|
| |
| | | | | | | | | | | | | | |
