cirus
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A 5-month-old male infant has a urine output of less than 0.1 mL/kg/hr shortly after undergoing
major surgery. On examination, he has generalized edema. His blood pressure is 94/48 mm
Hg, pulse is 140/min, and respirations are 20/min. His blood urea nitrogen is 38 mg/dL, and
serum creatinine is 1.4 mg/dL. Initial urinalysis shows a specific gravity of 1.018 and 2+
protein. Microscopic examination of the urine sample reveals 1 WBC per high-power field
(HPF), 18 RBCs per HPF, and 5 granular casts per HPF. His fractional excretion of sodium is
3.2 %. Which of the following is the most appropriate next step in diagnosis?
A. CT of the abdomen and pelvis
B. Cystourethrography
C. Intravenous pyelography
D. Renal biopsy
E. Renal ultrasonography
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| Justice
Forum Fanatic
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C. Intravenous pyelography - to assess the renal glomerulal blood flow and filtration
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| kingsofke
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A. CT of the abdomen and pelvis
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| cirus
Forum Guru
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The ans E.renal ultrasound(from kaplan qbank) but the explanation wasn't there..does anyone know why??
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| kavi
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this kid has low urine output, elevated BUN and fractional excretion on sodium >1 points towards ARF.
And seeing this had happened following major surgery would suspect some obstruction and hence evaluate for dilation with renal U/S.
Cant do IVP as he has poor renal function.
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| virgola82
Forum Guru
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He should have ATN following surgery so I think U/S (option E) could detect it, am not sure though...
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