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AKI Case 2

Educational resources for renal medicine

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Case 2

A 47 year old man is referred to you in A&E by his GP. He has been complaining of nausea and vomitting, swollen legs and left sided back pain over the last few days. His GP, whom he has never attended before, notes oedema, blood in the urine and a tender left flank. The patient describes a history of sometimes seeing red or dark urine over the past 6 months with gradually smaller amounts being passed in the last few days. He has not passed any urine in the last 24 hours.

  Blood results show: Sodium 136mmol/l (135-145)
    Potassium 5.9mmol/l (3.6-5.0)
    Total C02 14mmol/l (22-30)
    Urea 47.1mmol/l (2.5-6.6)
    Creatinine 711umol/l (60-120)
    eGFR 8mls/min  


On attending A&E, the patient is sitting upright with a respiratory rate of 35 breaths per minute.

Blood pressure is 170/100, heart rate 105 regular.

His neck veins are visible and his JVP is elevated at 8cm.

His heart sounds are normal but respiratory examination demonstrates bibasal dullness and basal fine crepitations.

He has pitting oedema to his mid-thighs.

A urinary catheter is passed. There is 20mls of blood stained urine in his bladder. Over the next hour no urine is passed.



Question 1

What do you think is the likely diagnosis?

Write your answer here:


Question 2

What two diagnostic tests will give you the most immediately useful information in these circumstances?

Write your answer here:

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Page last modified 30.11.2016, 10:07 by Emma Farrell. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.