A Long Road to Diagnosis: A Case with Unexpected Twists
Notice bibliographique
Résumé
Introduction: It is often thought that cases of obstructive acute kidney injury (AKI) are straightforward to diagnose and manage. The following case report explores how experienced physicians navigated an unusual case and the convoluted path taken to arrive at the eventual diagnosis. Case Description: A 74 year-old previously healthy male presented to the hospital with syncope in the context of six weeks of nausea, vomiting, anorexia and one year of nocturia. Labwork showed potassium of 8.1mmol/L and creatinine (Cr) of 14.97mg/dL (baseline of 1.07mg/dL). EKG showed peaked T-waves. After management of hyperkalemia, significant arrhythmias persisted so dialysis was initiated. A renal ultrasound showed bilateral hydronephrosis and ascites. Presuming prostactomegaly as the case of the obstruction, a foley catheter was placed and drained 445mL of urine, but he became oligoanuric. Urine microscopy showed one heme-granular cast. Urine albumin to creatinine ratio was 101mg/g. A serologic work-up was negative and kidney biopsy was consistent with acute tubular necrosis (ATN). However, a repeat ultrasound showed no improvement in bilateral hydronephrosis and ascites. A paracentesis revealed malignant cells on cytology. Discussions were held regarding pursuing a contrast-enhanced CT for work-up of malignancy. However, in the context of severe AKI, a shared decision was made to delay the CT as it can impede renal recovery. Serum tumor markers revealed elevated Ca19-9, CA125, and CEA. A colonoscopy showed two colonic masses. We obtained a contrast-enhanced CT as we felt the potential information we would gain outweighed the risks, which showed metastatic malignancy with retroperitoneal masses causing bilateral ureteric obstruction and hydronephrosis. Nephrostomy tubes were inserted and the patient experienced significant renal recovery. He was discharged with a Cr of 1.4 mg/dL (eGFR of 53mL/min/1.73m2). Discussion: From this case, we learned it is imperative to re-evaluate initial assumptions when an element of the case is unusual, such as why he became oligoanuric after a foley was placed if the obstruction was relieved and why he had new-onset ascites. Persistent anomalies prompted additional studies, which led to the uncovering of the previously unknown metastatic malignancy, the true cause of the patient's AKI. This case highlighted the dangers of early diagnostic closure and the importance of thorough investigation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».