Failure to thrive in a man in his late forties

Clinical presentation A man in his late 40s with a 30 pack-year cigarette smoking history and no other comorbidities presents with failure to thrive. He first presented to an outside institution in 2016 with haematuria and 3 months later with volume overload secondary to renal failure. Bilateral ureteral strictures, hydronephrosis and a small contracted bladder consistent with ketamine bladder syndrome were noted. Bilateral percutaneous nephrostomy tubes were placed. Cystoscopy and biopsy revealed severely inflamed bladder with denuded epithelium and eosinophilic bodies in the stroma. He presented to our institution 1 month later for second opinion. Laboratory investigation The white cell count was 9.47x109/L, (normal 3.12–8.44 x 109/L), red count 4.01, (4.20–5.73 x 1012/L), haemoglobin 94 g/L (126–170 g/L), haematocrit 0.303 (0.372–0.479), platelet count 690x109/L (156–325 x 109/L). The sodium concentration was 128 (135–147 mmol/L), potassium 6.2 (3.2–5.2 mmol/L), chloride 105 (97–107 mmol/L), bicarbonate 18 (23–27 mmol/L), blood urea nitrogen 27.8 (2.5–7.14 mmol/L), creatinine 221 (53.04–106.08 μmol/L). Aspartate aminotransferase...
Source: Journal of Clinical Pathology - Category: Pathology Authors: Tags: Grand rounds Source Type: research