04-26-2009, 12:30 PM
A 69-year-old man is evaluated during a routine physical examination. He has a history of hypertension, hyperlipidemia, osteoarthritis of the knees, and cigarette smoking. Medications are hydrochlorothiazide, 25 mg/d; atenolol, 25 mg/d; simvastatin, 20 mg/d; and acetaminophen as needed. Six months ago, a urinalysis performed by another physician during evaluation for an upper respiratory infection revealed 2+ blood without proteinuria; previous urinalyses were normal. His physical examination is unremarkable.
Laboratory Studies
Blood urea nitrogen 12 mg/dL
Creatinine 1.1 mg/dL
Sodium 138 meq/L
Potassium 4.2 meq/L
Bicarbonate 25 meq/L
Urinalysis pH 5.0, specific gravity 1.015, 2+ blood, 5“10 intact erythrocytes/hpf without casts
Spiral CT of the abdomen reveals a 2.5-cm simple cyst in the upper pole of the right kidney and no hydronephrosis.
Which of the following is the most appropriate next step in the evaluation of this patient's hematuria?
a. repeat urine analysis in 2 months
b. cystoscopy
c.kidney biopsy
d.ciprofloxacin
e.observation
Laboratory Studies
Blood urea nitrogen 12 mg/dL
Creatinine 1.1 mg/dL
Sodium 138 meq/L
Potassium 4.2 meq/L
Bicarbonate 25 meq/L
Urinalysis pH 5.0, specific gravity 1.015, 2+ blood, 5“10 intact erythrocytes/hpf without casts
Spiral CT of the abdomen reveals a 2.5-cm simple cyst in the upper pole of the right kidney and no hydronephrosis.
Which of the following is the most appropriate next step in the evaluation of this patient's hematuria?
a. repeat urine analysis in 2 months
b. cystoscopy
c.kidney biopsy
d.ciprofloxacin
e.observation