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Bad Beans

Updated: Feb 25

This week in clinic I saw a 48 year old male. We'll call him Juan (because that's his name).

Juan had multiple vague symptoms (excessive salivation, occasional diarrhea, generalized fatigue, etc.). It was his first visit to our center. He denied any significant past medical history. Aside from mildly elevated blood pressure, his vitals signs were within normal limits and his physical exam was not exciting. At a bit of a loss, I reached for our ultrasound probe.

His abdominal ultrasound was not normal. Specifically, his kidneys were markedly abnormal. His right kidney is pictured below. His left kidney, unfortunately, had a very similar appearance. Severe hydronephrosis with dilation of renal pelvis, cortical thinning, and evidence of nephrolithiasis. Scanning the remainder of his abdomen and pelvis did not reveal an alternative explanation for his bilateral severe hydro.

His labs were exciting. But, not in a good way. Creatinine 10.9, BUN 74. Indicative of very poor renal function.

Very bad beans.

Juan needs a Urologist and a Nephrologist.

Relieving obstruction caused by nephrolithiasis will perhaps allow for some recovery of renal function. But, barring significant improvement, he will undoubtedly require dialysis (assuming he opts to pursue that option... many patients here do not for a myriad of reasons). We will help him to navigate what can be a fragmented, complex, and frustrating healthcare landscape as best we can.

We typically associate kidney stones with pain (i.e. renal colic), but rarely death. In our patient's case it seems quite likely that his life will be truncated secondary to renal failure caused by obstruction.

The outcome could have (should have) been much different with more timely alleviation of obstruction.

Top Photo by Volodymyr Hryshchenko on Unsplash


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