David Alter, Author at Renal and Urology News - Page 4

David Alter

All articles by David Alter

Hemoglobinuria

Differential Diagnosis Intact or not red blood cells secondary to bleeding in the urinary tract Urinary tract infections are a common cause In older individuals, malignancy must be ruled out Clinical evidence for a neoplastic disease History of renal trauma History of blood transfusion History of burns Cause for renal infarction Suggested Additional Lab Testing…

Elevated WBC Count

Differential Diagnosis Consider white blood cell (WBC) proliferation in patients with infections and other inflammatory states, such as autoimmune disorders. An increase in neutrophils commonly occurs during a bacterial infection. Lymphocytosis can be found in tuberculosis (TB), acute bowel infections, and infectious mononucleosis. Monocyte count is usually increased along with an elevated lymphocyte count. Eosinophils…

Elevated TSH – Hypothyroidism

Differential Diagnosis Hashimoto thyroiditis Ablative hypothyroidism Infantile hypothyroidism Euthyroid sick syndrome Dangerous Situations Early diagnosis and treatment of infantile hypothyroidism with thyroid hormone prevents irreversible mental retardation and growth impairment. Commonly Encountered Situations Hashimoto thyroiditis accounts for about 90% of all hypothyroidism cases. Suggested Additional Lab Testing Hashimoto thyroiditis T4 is normal and then becomes…

Elevated Serum or Plasma Sodium

Differential Diagnosis Excessive parenteral sodium administration in an unconscious patient whose thirst mechanism is absent. Excessive use of diuretics or other drugs leading to water loss in the patient who cannot compensate by intake of water. Diabetes insipidus may be central (neurogenic), acquired nephrogenic, or congenital nephrogenic. Mineralocorticoid or glucocorticoid excess from primary hyperaldosteronism and…

Elevated Serum or Plasma Potassium

Differential Diagnosis An artifactually high value can occur with hemolysis of red blood cells (RBCs) during venipuncture, especially if there is prolonged tourniquet use and fist clenching during the drawing of the blood or at any time prior to potassium measurement. An artifactually high potassium value can also occur when there are greater than 1,000,000…

Elevated Serum Calcium

Differential Diagnosis Primary hyperparathyroidism Excess parathyroid hormone (PTH) secretion from a single parathyroid adenoma, hyperplasia of the parathyroids, parathyroid carcinoma Malignant tumors Especially tumors of the breast, lung, and kidney in which hypercalcemia may occur from direct bony metastasis Multiple myeloma that directly degrades bone Other cancers that produce hypercalcemia by inducing PTH secretion Excess…

Elevated Serum Amylase and/or Serum Lipase

Differential Diagnosis Acute pancreatitis Chronic pancreatitis Pancreatic carcinoma Dangerous Situations Pancreatic carcinoma is associated with a very short life span following diagnosis. Commonly Encountered Situations Acute pancreatitis is the most common of the disorders listed. Suggested Additional Lab Testing Acute pancreatitis Tests to assess alcohol intake and triglyceride levels are useful. Most common causes include…

Elevated Platelet Count

Differential Diagnosis Essential thrombocythemia with platelet count typically greater than 600,000/µL Reactive thrombocytosis from: inflammation infection malignancy iron deficiency anemia acute blood loss rebound from marrow suppression or immune thrombocytopenia post-splenectomy Dangerous Situations Platelet counts greater than 1,000,000/µL are worrisome for acute thrombotic events. Elevated platelet count with poorly functioning platelets does not present an…

Elevated Hemoglobin or Hematocrit

Differential Diagnosis Pt with true polycythemia with an increased red blood cell (RBC) mass. Pt with a relative polycythemia and a normal RBC mass as a result of dehydration or another state producing a low plasma volume. Dangerous Situations Polycythemia in which the RBC mass is high enough to impair blood flow. Commonly Encountered Situations…

Elevated Blood Lead Level

Differential Diagnosis Pt has slightly, moderately, or extremely elevated level of blood lead. The three levels have different clinical outcomes and recommended treatment. Dangerous Situations Blood lead levels greater than 70 µg/dL: treat as a medical emergency Levels 45-69 µg/dL: give immediate treatment with chelation therapy.

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