usmle6789
Forum Senior
Topics: 33
Posts: 49
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47 yr old woman who is visiting from Australia comes to the physician because of increased urinary output for 1 month. No dysuria and hematuria. She has h/o UTI, PUD, chronic headaches. An evaluation 18 months ago for headaches including ct scan of head showed normal. Treatment with ibuprofen and phenacetin was initiated at that time and her headaches were well controlled. T 37.1c[98.8] , 140/ 82, pulse 78, rr 14. physical examination is normal.
Lab values------ hematocrit 32%
MCV----------88
SERUM GLUCOSE-130
SERUM CREATININE----- 1.7
URINE
PROTEIN 2+
WBC 8- 10
RBC NONE
BACTERIA NONE
NITRATES NONE
Fecal occult blood test is negative. Most appropriate next step in management?
1] intravenous pyelography
2] D/C current meds
3] upper endoscopy
4] insulin therapy for DM
5] antibiotics for recurrent UTI.
I think answer is 2. Plz confirm.
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| mikyro
Forum Junior
Topics: 0
Posts: 81
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47 yr old woman who is visiting from Australia comes to the physician because of increased urinary output for 1 month. No dysuria and hematuria. She has h/o UTI, PUD, chronic headaches. An evaluation 18 months ago for headaches including ct scan of head showed normal. Treatment with ibuprofen and phenacetin was initiated at that time and her headaches were well controlled. T 37.1c[98.8] , 140/ 82, pulse 78, rr 14. physical examination is normal.
Lab values------ hematocrit 32%
MCV----------88
SERUM GLUCOSE-130
SERUM CREATININE----- 1.7
URINE
PROTEIN 2+
WBC 8- 10
RBC NONE
BACTERIA NONE
NITRATES NONE
Fecal occult blood test is negative. Most appropriate next step in management?
1] intravenous pyelography
2] D/C current meds
3] upper endoscopy
4] insulin therapy for DM
5] antibiotics for recurrent UTI.
I think answer is 2. Plz confirm.
So, let's sume up:
increased urinary output for 1 month
No dysuria and hematuria
hematocrit 32%
MCV----------88
SERUM GLUCOSE-130
SERUM CREATININE----- 1.7
URINE PROTEIN 2+
WBC 8- 10
Dx: chronic pyelonephritis, anemia of chronic disease, DM
Next: 2 - Next: 1
Hope I'm right :icon_scratch:
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the same miky - always ready to help my patients and friends as well
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| ELM
Forum Guru
Topics: 28
Posts: 936
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Anesthetic (NSIAD) indused nephropathy----> may lead to chronic renal failure! Polyuria, protienuria, anemia due to decreased EPO ...all from failed kidneys.....must stop the NSIADs now.
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ELM
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| tamriko
Forum Elite
Topics: 23
Posts: 296
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I will go with 2 also.
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| SA
Forum Elite
Topics: 21
Posts: 193
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Can any one till me is it time related or dose related or can occure any time during treatment with NSAID?
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| ELM
Forum Guru
Topics: 28
Posts: 936
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Time and dose related....long time and high doses of NSAID.
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ELM
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| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
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Stop meds first, this is most likely NSAID induced nephropathy.
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| Veer-Zaara
Forum Elite
Topics: 16
Posts: 268
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I agree stop medication.This is chronic interstitial nephritis.
Analgesics can cause acute renal failure and tubular necrosis too.
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