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What Do My Lab Test Reports Indicate?
Question: Please advise the best treatment options for the following patient who just performed urine, blood & ultrasound tests:
Male/85 year old on low-protein diet and CKD medication (Cilacar-10 Cilnidipine for high BP, Acidose Sodium Bicarbonate 500mg, Dytor-20 Torsemide diuretic, Shelcal-CT 500mg for Calcium/Calcitrol, etc.)
Latest Diagnostics:
Weight: 45kg, B.Sugar 135 (fasting), PSA=normal, B.Urea 146, S.creatinine 9.0, Hgb 5.4 gm/dl, Hct 17.4%, BP 180/90.
Urine test: Alb +++, Pus cells 1-2/hpf, Epi cells Nil, RBCs Nil, Culture yield bacterial growth after 48 hours of aerobic.
KUB UltraSound scan: Liver normal, Kidney Right=8.7x4.4 cm, Parenchymal echo pattern=increased, CMD not maintained, Pelvicalyceal system --, Calculi -- Kidney Left: 11.2x5.2 cm, Hyper echoic, CMD maintained, Pelvicalyceal system=Mild to moderate hydronephrosis.
Urinary bladder: moderately distended, Curves shows many echogenic particles, bladder wall thickened & irregular.
Male/85 year old on low-protein diet and CKD medication (Cilacar-10 Cilnidipine for high BP, Acidose Sodium Bicarbonate 500mg, Dytor-20 Torsemide diuretic, Shelcal-CT 500mg for Calcium/Calcitrol, etc.)
Latest Diagnostics:
Weight: 45kg, B.Sugar 135 (fasting), PSA=normal, B.Urea 146, S.creatinine 9.0, Hgb 5.4 gm/dl, Hct 17.4%, BP 180/90.
Urine test: Alb +++, Pus cells 1-2/hpf, Epi cells Nil, RBCs Nil, Culture yield bacterial growth after 48 hours of aerobic.
KUB UltraSound scan: Liver normal, Kidney Right=8.7x4.4 cm, Parenchymal echo pattern=increased, CMD not maintained, Pelvicalyceal system --, Calculi -- Kidney Left: 11.2x5.2 cm, Hyper echoic, CMD maintained, Pelvicalyceal system=Mild to moderate hydronephrosis.
Urinary bladder: moderately distended, Curves shows many echogenic particles, bladder wall thickened & irregular.
Brief Answer:
Needs immediate attention
Detailed Answer:
Hello
Thanks for the query
From the investigations you have provided it looks like you are suffering from advanced CKD as there is loss of CMD and very high creatinine and low hemoglobin.
If I were to be your doctor I would have taken the following steps
1. Relieved the hydronephrosis by asking for a urological opinion for hydronephrosis. Renal stone could causing the mild to moderate hydronephrosis. Once relieved there are chances serum creatinine might come down
2. Anemia is of immediate concern, I recommend sending for serum iron studies, you will require a combination of iron replacement with IV/Oral iron, erythropoetin and atleast one blood transfusion
3. Blood pressure is not under control. I recommend adding centrally acting anti hypertensives like Clonidine three times a day for better control. Another option would be to add Prazocin twice a day. Once serum creat settles one can add ACE inhibitors like Enalapril to control protein loss in urine
4. Fasting blood sugar is slightly high, but I prefer higher fasting blood sugars in elderly and I donot recommend very tight control
5. Urinary bladder thickened in the absence of pus cells in urine, please get a cystoscopy done to rule out any kind of bladder lesions
I hope I was of help, if you have any further queries please get back to me
Regards
Needs immediate attention
Detailed Answer:
Hello
Thanks for the query
From the investigations you have provided it looks like you are suffering from advanced CKD as there is loss of CMD and very high creatinine and low hemoglobin.
If I were to be your doctor I would have taken the following steps
1. Relieved the hydronephrosis by asking for a urological opinion for hydronephrosis. Renal stone could causing the mild to moderate hydronephrosis. Once relieved there are chances serum creatinine might come down
2. Anemia is of immediate concern, I recommend sending for serum iron studies, you will require a combination of iron replacement with IV/Oral iron, erythropoetin and atleast one blood transfusion
3. Blood pressure is not under control. I recommend adding centrally acting anti hypertensives like Clonidine three times a day for better control. Another option would be to add Prazocin twice a day. Once serum creat settles one can add ACE inhibitors like Enalapril to control protein loss in urine
4. Fasting blood sugar is slightly high, but I prefer higher fasting blood sugars in elderly and I donot recommend very tight control
5. Urinary bladder thickened in the absence of pus cells in urine, please get a cystoscopy done to rule out any kind of bladder lesions
I hope I was of help, if you have any further queries please get back to me
Regards
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Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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