nida
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Harrison's Q
In the emergency room a male patient presents with complaints of right flank pain without radiation during micturition and intermittent polyuria with other periods of decreased urine output. The patient denies having dysuria, hematuria, and fever. He denies any significant past medical history, and a review of all other symptoms is negative. Examination shows normal vital signs, and there is a normal abdominal examination except for mild costophrenic angle tenderness on the right. Rectal examination shows no tenderness, and there is a normal prostate examination. There is no edema in the lower extremities. Urinalysis is bland without pyuria, bacteria, or casts. Serum blood urea nitrogen (BUN) and creatinine are 50 mg/dL and 2.0 mg/dL, respectively. Renal ultrasound shows bilateral hydronephrosis. What is the most likely diagnosis?
A. Acute cystitis
B. Genitourinary tuberculosis
C. Nephrolithiasis
D. Transitional cell carcinoma of the bladder
E. Vesicoureteral reflux disease
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| cyra
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E
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| msyamp
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E
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| som
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E
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| MAZI
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E
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| nida
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The answer is E.
This patient probably has acute renal failure caused by urinary tract obstruction. Ultrasonography is 90% sensitive and specific for the detection of hydronephrosis. Although urinary tract obstruction can be due to many disease processes, including congenital abnormalities and acquired intrinsic and extrinsic defects of the urinary tract, this patient's symptoms are classic for vesicoureteral reflux disease. Infection must be ruled out as it is often superimposed, but this patient's urinalysis and examination are not consistent with an infectious etiology. Nephrolithiasis would present more typically with a constant pattern of pain with radiation to the lower abdomen, testes, or labia. Although genitourinary tumors may also result in obstruction, the pattern of pain is often less acute and other structural abnormalities may be seen on imaging. Diagnosis of vesicoureteral reflux disease may be confirmed with voiding cystourethrography.
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| AAAAA
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e
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