Deteriorating renal function in the asymptomatic patient: the importance of clinical examination!
- 1Department of General Medicine, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
- 2Department of Renal Medicine, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
- Correspondence to Dr Ahmed Seedat,
An 81-year-old gentleman was referred to the medical team by his general practitioner (GP) with a biochemically worsening renal function. Medical history included hypertension, chronic kidney disease and a 67 pack-year smoking history. Significantly, there was a history of angiotensin-converting enzyme inhibitor (ACE-i) use 3 months previously. The patient was otherwise asymptomatic. Admission bloods: Na 135 mmol/l, K 5.7 mmol/l, urea 32.7 mmol/l, creatine 358 μmol/l (baseline 150 μmol/l), estimated-glomerular filtration rate (eGFR) 14ml/min. On examination, there was a large, non-tender pulsatile mass in the abdomen. Otherwise the systems examination was …