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Old 09-18-2014
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Post Renal Question

A 55-year-old man admitted to the hospital because of complications of alcoholic cirrhosis and concurrent hepatitis C infection progressively develops an increase in serum blood urea nitrogen and creatinine levels, followed closely with urine output of less than 300 mL/day. Urinalysis reveals a sodium concentration of 5 mEq/L and the presence of benign urinary sediment. No proteinuria or hematuria is present.

Imaging of this patient's kidneys is likely to reveal which of the following?

A.Enlarged cystic kidneys
B.Enlarged kidneys with severe hydronephrosis
C.Horseshoe kidneys
D.Normal kidneys with "flea-bitten" infarcted appearance
E.Normal size and shape
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E.Normal size and shape
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Old 09-18-2014
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E.
Advanced liver disease may develop renal failure > HEPATORENAL SYNDROME
kidneys are histologically NORMAL.
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Quote:
Originally Posted by DrNewB View Post
A 55-year-old man admitted to the hospital because of complications of alcoholic cirrhosis and concurrent hepatitis C infection progressively develops an increase in serum blood urea nitrogen and creatinine levels, followed closely with urine output of less than 300 mL/day. Urinalysis reveals a sodium concentration of 5 mEq/L and the presence of benign urinary sediment. No proteinuria or hematuria is present.

Imaging of this patient's kidneys is likely to reveal which of the following?

A.Enlarged cystic kidneys
B.Enlarged kidneys with severe hydronephrosis
C.Horseshoe kidneys
D.Normal kidneys with "flea-bitten" infarcted appearance
E.Normal size and shape
Correct answer is EE.

This is a case of hepatorenal syndrome.

Even if you couldnt get the diagnosis by looking at the stem, we can see that the urine Na conc. is 5meq/l. Urine conc. less than 20 is pre renal. ( page 544 FA 2014)
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Old 09-18-2014
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Quote:
Originally Posted by DrNewB View Post
A 55-year-old man admitted to the hospital because of complications of alcoholic cirrhosis and concurrent hepatitis C infection progressively develops an increase in serum blood urea nitrogen and creatinine levels, followed closely with urine output of less than 300 mL/day. Urinalysis reveals a sodium concentration of 5 mEq/L and the presence of benign urinary sediment. No proteinuria or hematuria is present.

Imaging of this patient's kidneys is likely to reveal which of the following?

A.Enlarged cystic kidneys
B.Enlarged kidneys with severe hydronephrosis
C.Horseshoe kidneys
D.Normal kidneys with "flea-bitten" infarcted appearance
E.Normal size and shape
This question has been posted earlier! It's E
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