Michael Laposata, Author at Renal and Urology News - Page 3

Michael Laposata

All articles by Michael Laposata

Ketonuria

Differential Diagnosis Diabetic ketoacidosis (DKA) Starvation Suggested Additional Lab Testing Anion gap is commonly measured in patients with DKA. Management of DKA involves serial measurements of electrolytes, glucose, and blood gases in the acute setting to follow clinical progress. Clinical Considerations History of diabetes in a patient who presents with ketonuria and appropriate signs and…

INR Above or Below the Therapeutic Range

Differential Diagnosis Increased INR, Coumadin over-dosage; low INR, inadequate Coumadin dosage Clinical conditions that increase Coumadin effect and elevate INR include: Hyperthyroidism Low vitamin K intake Poor nutritional state Diarrhea Liver disease Congestive heart failure Cancer Connective tissue diseases High fever Conditions known to decrease Coumadin effect and decrease INR include: Hypothyroidism High vitamin K…

Increased Urinary Protein

Differential Diagnosis Glomerular membrane damage Impaired tubular reabsorption of protein Multiple myeloma Preeclampsia Diabetic nephropathy Suggested Additional Lab Testing Initial evaluation for renal function with serum or plasma BUN and/or creatinine If there is concern about an undiagnosed case of diabetes mellitus, evaluation for diabetes If there is concern about multiple myeloma, serum protein electrophoresis

Increased Urinary Glucose

Differential Diagnosis Diabetes mellitus Impaired tubular reabsorption of glucose Pregnancy with latent diabetes mellitus Suggested Additional Lab Testing Serum or plasma BUN and/or creatinine is useful to initially evaluate renal function. Evaluate for diabetes mellitus if not already done.

Increased Serum Aldosterone

Differential Diagnosis Primary hyperaldosteronism Secondary hyperaldosteronism Suggested Additional Lab Testing Primary hyperaldosteronism Serum potassium is usually low, but a low-sodium diet may result in a normal value. Serum sodium is mildly elevated in most cases. Plasma renin activity is low for most cases of hyperaldosteronism. The low value for plasma renin makes the ratio of…

Increased PTT Only: A Prolonged PTT with a Normal PT

Differential Diagnosis Heparin in the specimen, which may be a result of heparin treatment of the patient Treatment with low molecular weight heparin, argatroban, or lepirudin A lupus anticoagulant (i.e., lupus inhibitor) Deficiency of factor VIII (hemophilia A) or IX (hemophilia B) Deficiency of factor VIII (mild or severe) associated with von Willebrand’s disease Deficiency…

Increased PT Only: A Prolonged PT with a Normal PTT

Differential Diagnosis Initiation of Coumadin therapy or a very low dose of Coumadin Inadequate intake of foods rich in vitamin K, such as cauliflower, broccoli, chick peas, other leafy vegetables A stimulus for disseminated intravascular coagulation (DIC) Evidence of liver disease from clinical or laboratory parameters Family history of bleeding that could be associated with…

Increased PT and Increased PTT

Differential Diagnosis Coumadin therapy in the therapeutic or supratherapeutic range Moderate to severe vitamin K deficiency Treatment with high doses of heparin or low molecular weight heparin Treatment with direct thrombin inhibitors, such as hirudin or related compounds (i.e., lepirudin, refludan) or argatroban Moderate to severe DIC Moderate to severe liver disease A lupus inhibitor…

Increased D-Dimer or FDP

Differential Diagnosis DIC Thrombosis: can be venous with pulmonary embolism (PE) and/or deep vein thrombosis (DVT) or arterial, as caused by peripheral artery thrombosis, myocardial infarction, and stroke Pulmonary Embolism Infections Complications of pregnancy Malignancy Trauma Burns Suggested Additional Lab Testing D-dimer levels over the course of hours to days to determine if D-dimer levels…

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