sandra
Forum Guru
Topics: 179
Posts: 423
|
A 47-year-old woman who is visiting from Australia
comes to the
physician because of increasing urine output over the
past month. She has had
no dysuria or hematuria. She has a history of chronic
headaches,
peptic ulcer disease, and urinary tract infections.
An evaluation 18 months
ago for headaches, including CT scan of the head,
showed no
abnormalities; treatment with ibuprofen and phenacetin
was initiated at that time,
and her headaches have been well controlled. Her
temperature is 37.1 C
(98.8 F), blood pressure is 140/82 mm Hg, pulse is
78/min, and
respirations are 14/min. Examination shows no
abnormalities. Laboratory
studies show:
Hematocrit 32%
Mean corpuscular volume 88 μm3
Serum
Glucose 130 mg/dL
Creatinine 1.7 mg/dL
Urine
Protein 2+
WBC 8–10/hpf
RBC none
Bacteria none
Nitrates none
Test of the stool for occult blood is negative. Which
of the following
is the most appropriate next step in management?
A
) Intravenous pyelography
B
) Discontinue current medication
C
) Antibiotic therapy for recurrent urinary tract
infections
D
) Insulin therapy for diabetes mellitus
E
) Upper endoscopy
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| nyimalay
Forum Elite
Topics: 9
Posts: 280
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B
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| Miradautas Vras
Forum Senior
Topics: 8
Posts: 154
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APN due to NSAIDS. Isolated pyuria.
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| hope4dabest
Forum Elite
Topics: 16
Posts: 433
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Does Pyelonephritis occurs due to NSAID's ???
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| farnsworth
Forum Newbie
Topics: 0
Posts: 165
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the patient has most likely an interstitial nephritis from NSAID (ab-)use -> B
No hint for glomerulonephritis, nephrotic syndrome, or bacterial cystits/pyelonephritis
(btw: 0 - 10WBCshpf is considered normal, so pyuria is a bold diagnosis... ;-)
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| shahnaz.r
Forum Junior
Topics: 6
Posts: 72
|
DDx:
1] NSAID nephropathy
2] Diabetic nephropathy
3] UTI
most appropriate next step is probably B?
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