Evaluation of impaired renal function in a male with abdominal pain?

From the Guidelines

Impaired renal function in a male with abdominal pain should be evaluated with a thorough history, physical examination, and laboratory analysis, including serum creatinine and urine tests.

Evaluation Approach

The evaluation approach for impaired renal function in a male with abdominal pain involves:

• A thorough history to identify potential causes of renal impairment, such as hypertension, diabetes, or previous kidney disease 1
• A physical examination to assess for signs of renal disease, such as edema or hypertension 1
• Laboratory analysis, including:
  • Serum creatinine to estimate glomerular filtration rate (GFR) 1
  • Blood urea nitrogen (BUN) to assess for azotemia 1
  • Urine tests, including microscopy for casts and epithelial cells, chemistry, and biomarkers 1

Diagnostic Criteria

The diagnosis of acute kidney injury (AKI) is based on an increase in creatinine by 0.3 mg/dL within 48 hours or an increase in serum creatinine to 1.5 times baseline (within prior 7 days) or urine volume 0.5 mL/kg/hr for 6 hours 1.

Imaging Studies

Imaging studies, such as multi-phasic CT urography (CTU), may be necessary to evaluate the renal parenchyma and upper tracts, especially if there is suspicion of a renal mass or urothelial disease 1. However, the use of iodinated contrast should be carefully considered in patients with impaired renal function due to the risk of contrast-induced nephropathy 1.

Risk Factors

Patients with hypertension and diabetes are at increased risk for chronic kidney disease (CKD) and should be closely monitored for signs of renal impairment 1.

Management

The management of impaired renal function in a male with abdominal pain depends on the underlying cause and may involve consultation with a nephrologist to weigh the risks and benefits of different imaging modalities and treatment options 1.

From the Research

Evaluation of Impaired Renal Function

The evaluation of impaired renal function in a male with abdominal pain involves considering various potential causes, including renal infarction, ruptured bladder, and renal artery dissections.

• Renal infarction is a condition that may present with non-specific symptoms, including abdominal pain, and is often not considered initially in the differential diagnosis 2.
• A raised serum creatinine level and lactate dehydrogenase (LDH) activity are classic indicators of renal infarction, and most patients have haematuria 2.
• Typical wedge-shaped perfusion defects are visible on a CT-scan with intravenous contrast, which can aid in the diagnosis of renal infarction 2.

Differential Diagnosis

The differential diagnosis for impaired renal function in a male with abdominal pain also includes:

• Ruptured bladder, which can cause pseudorenal failure due to 'reversed autodialysis' 3, 4.
• Renal artery dissections, which can occur spontaneously or due to underlying connective tissue disorders, and may present with abdominal pain and renal insufficiency 5.
• Other potential causes, such as dialysis-related peritonitis, acute gastroenteritis, and antibiotic-related encephalopathy, should also be considered 6.

Diagnostic Approach

A comprehensive diagnostic approach is necessary to evaluate impaired renal function in a male with abdominal pain, including:

• Laboratory tests, such as serum creatinine and LDH activity, to assess renal function and detect potential indicators of renal infarction or other causes 2, 3.
• Imaging studies, such as CT-scans, to visualize the kidneys and detect perfusion defects or other abnormalities 2, 5.
• Ascitic fluid analysis, which can help diagnose urinary ascites secondary to intraperitoneal bladder rupture 4.