All Wrapped Up and Nowhere to Flow
When imaging revealed a mass, the differential diagnosis encompassed several possibilities. A 55-year-old white man was admitted for evaluation of acute kidney injury. Right-sided flank discomfort had worsened over the previous year, culminating in significant pain that now warranted evaluation. He denied fever, weight loss, night sweats, hematuria, dysuria, and oliguria. His past medical history was significant for a 3.8-cm infrarenal abdominal aortic aneurysm that had last been imaged 2 years earlier. In addition, he had hyperlipidemia, a multinodular goiter, and back spasms. He quit smoking cigarettes 10 years earlier with a 30 pack-year history. Family history was notable for an abdominal aortic aneurysm in his father.
The patient’s only medication was nortriptyline for back pain. An HMG-CoA-reductase inhibitor had not been prescribed due to myalgias. Two years before admission, his creatinine was 1.2 mg/dL; 2 months prior to admission, it was 1.7 mg/dL. At the time of evaluation, laboratory studies demonstrated a blood urea nitrogen level of 71 mg/dL and a creatinine level of 6.7 mg/dL. His estimated glomerular filtration rate was 9 mL/min/1.73 m2 per the Modification of Diet in Renal Disease equation.
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–Amir A. Naderi, MD, Brian A. Houston, MD, C. John Sperati, MD, MHS
–This article originally appeared in the September 2012 issue of The American Journal of Medicine.
