Consider a 65 year-old male presenting with right-sided flank pain radiating to the groin. The following CT scan was taken to confirm a presumed diagnosis of renal colic:
Questions
Q1. Describe the CT scan
CT scan is non-contrast; however, there is:
- right-sided retroperitoneal blood evident.
- an abdominal aortic aneurysm.
It is important to remember that the commonest cause of the ‘classic’ presentation of renal colic amongst patients presenting to have a post-mortem is ruptured abdominal aortic aneurysm.
This patient needs an emergency AAA repair.
The patient was taken to theatre for emergency surgery.
The following biochemistry results were taken post-operatively:
Q2. Describe the biochemistry. What diagnosis is suggested by these biochemical findings?
Biochemistry demonstrates acute renal failure with a reduced urea-to-creatinine ratio.
The likely diagnosis is rhabomyolysis in this clinical context. Features suggestive of this diagnosis are:
- increased urea and creatinine with a reduced urea-to-creatinine ratio
- hyperphosphataemia, hypocalcaemia, hyperkalaemia
- metabolic acidosis
- increased CK (usually to greater than 40,000)
- Although not measured here, AST, and LDH are also increased in rhabdomyolysis
Q3. What are the other potential causes of renal failure to consider in this clinical situation?
- hypovolaemia from bleeding
- renal artery occlusion during operation
- use of contrast in pre-operative CT scan (not in this case)
- use of nephrotoxic drugs like gentamicin
- low cardiac output from peri-operative myocardial infarction
- abdominal compartment syndrome
Related posts:
About Paul Young
‘In the Fast Lane’: Renal Riddle #001 http://su.pr/18dVk7 It’s not a problem with the kidney… or is it?
This comment was originally posted on Twitter
AAA presenting as renal colic. I have not seen that. Cool.
http://lifeinthefastlane.com/2009/12/renal-riddle-001/
This comment was originally posted on Twitter
RT @kidney_boy: AAA presenting as renal colic. I have not seen that. Cool.
http://lifeinthefastlane.com/2009/12/renal-riddle-001/
This comment was originally posted on Twitter
great. thanks for the mention.
This comment was originally posted on Suture for a Living
Great post…I have to tell you, after hitting most of your recommendations, you are right on to mention them all. Now, though, I am ready to collapse in a great fit of sleep!
Thanks, as always, for a great post!
This comment was originally posted on Suture for a Living
Fantastic post
Congratulations on a great start to the 2010 collection of SurgeXperiences.
Has stimulated the team to write more surgical related posts (from the ED perspective)
Mike
This comment was originally posted on Suture for a Living