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Example text
Imaging The test to perform at the first outpatient attendance would be an abdominal radiograph of the kidneys, ureter and bladder, which would show any radio-opaque stones. The single most useful test to look for stones within the urinary tract would be an unenhanced CT of the kidneys, ureters and bladder. An intravenous urogram would offer a reasonable alternative to CT. Ultrasonography of the kidneys would be the appropriate test if obstruction were suspected, but there is nothing in the letter of referral to suggest that this is likely in this case.
Evidence of cardiac dysfunction, eg postoperative chest pain may go unnoticed but be an indication of myocardial infarction. 1 for discussion). Check in particular for features to support the diagnosis of renal hypoperfusion or postrenal problems. Evidence of likely renal hypoperfusion • Hypotension and postural hypotension (lying and sitting). • Low JVP. • Bladder outflow obstruction, particularly in elderly men due to prostatic enlargement: is the catheter properly positioned and draining freely?
Particular attention should be paid to the trend as well as the absolute values of abnormalities: if these are getting worse day by day, do not wait until they are extreme before seeking advice from renal services. Once the need for renal replacement therapy becomes clear, usually in the context of oliguria and worsening renal function, there is no point delaying its commencement until there is an emergency indication. • Always consider sepsis and set a low threshold for commencing broad-spectrum (non-nephrotoxic) antibiotics.