“Blood in My Urine”

Chief Complaint

  • 64 year old female presented to the ED with blood in the urine and right-sided abdominal pain

HPI

  • Pain started yesterday and is progressively worsening.
  • Pain comes and goes, is “aching”, radiates to right groin
  • Has noticed blood-tinged urine today
  • Chronic “smoker’s” cough
  • Review of systems otherwise negative

PMH

  • Hypertension, well-controlled on lisinopril/hydrochlorothiazide
  • Coronary Artery Disease, s/p DES to LAD 5 years ago, on aspirin, atorvastatin, metoprolol
  • Menopause at age 49

Family History

  • Non-contributory

Social History

  • Former smoker (40 pack-year history), quit 5 years ago after stent
  • Denies any illicit drug use
  • Social alcohol consumption

Vitals

Temp: 36.8° C, BP: 132/74 mmHg, HR: 95 bpm, RR: 12 rpm, SpO2: 95% on room air

Physical Exam

  • Abdomen tender to palpation in right upper and lower quadrants
  • Right-sided flank tenderness
  • Otherwise, normal exam (including genitourinary)

Lab

  • CBC, CMP, PT/INR significant for a calcium level of 13.2 mg/dL, creatinine of 1.4 mg/dL
  • Urinalysis shows 3+ blood, 2+ protein, no casts

Imaging

  • CT abdomen without contrast shows 6 mm obstructive renal stone at the right ureteropelvic junction with moderate right-sided hydronephrosis

What’s on your differential diagnosis?

What would you do next in the work-up for this patient?

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