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BMJ Case Reports 2013; doi:10.1136/bcr-2013-009125

Deteriorating renal function in the asymptomatic patient: the importance of clinical examination!

  1. Bassam Fallouh2
  1. 1Department of General Medicine, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
  2. 2Department of Renal Medicine, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
  1. Correspondence to Dr Ahmed Seedat, aseedat{at}doctors.org.uk

Description

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 …

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