Renal Case: 66-year-old Man with Voiding Symptoms

00:01 Let's move on to another case.

00:03 You're asked to see a 66-year-old gentleman who is admitted with obstructive voiding symptoms.

00:08 He was complaining of some hesitancy, dribbling, double voiding which are really reminiscent of lower urinary tract symptoms His symptoms interestingly worsened after taking an over the counter cold medicine.

00:21 On physical exam, he was very tender to palpation over his suprapubic region and he complained that he felt very full.

00:29 His labs were remarkable for a serum creatinine of 2 (mg/dL) .

00:32 we can see that that's elevated and his BUN was elevated as well at 49 (mg/dL) When looking at his urine analysis and microscopy looking at a sediment, it was pretty bland, there was nothing in there that was concerning.

00:44 So the question is, what type of acute kidney injury does this gentleman have? Again, let's go through that case and see if we can answer some questions for ourselves and arrive at the diagnosis So in the history, the fact that this gentleman is over the age of 50 and he's complaining of lower urinary tract symptoms - those are the things like the hesitancy, the dribbling, the double voiding.

01:06 That's very suggestive of BPH or benign prostatic hyperplasia.

01:12 He took a cold medicine remember, and what do cold medicines have in them? Oftentimes they have alpha agonists and that's important because alpha-agonists can increase the tone of the bladder neck and lead to a superimposed acute obstruction of urine outflow as in this particular setting.

01:31 The other thing that's important on his laboratory data is that his BUN to creatinine ratio is actually quite high in the setting of a bland urine.

01:39 It's very indicative, taken together with this history and physical exam of having the sensation of fullness in the bladder of really obstructive uropathy.

01:49 So this is a post-renal obstructive uropathy from benign prostatic hyperplasia or BPH.