UREMIA

Ask the Following Questions:

1. What is the BUN/creatinine ratio? If this ratio is 20:1 or greater, one should look for pre-renal azotemia. Confirmation with a serum and urine osmolality will be helpful. If this ratio is 10:1 or less, one should look for renal disease or obstructive uropathy.
2. Is the bladder enlarged, or is there significant residual urine? These findings point to obstructive uropathy, particularly bladder neck obstruction. If these findings are absent, the cause of the uremia is most likely renal disease in cases in which the BUN/creatinine ratio is 10:1 or less.

DIAGNOSTIC WORKUP

This should include a CBC, urinalysis, urine culture and colony count, serum and urine osmolality, chemistry panel, sedimentation rate, arterial blood gas analysis, blood volume, cystoscopy and retrograde pyelography, a nephrology consult, and a urology consult. Additional studies include abdominal CT scans, ultrasonography, and a renal biopsy.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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