Nephrology & Therapeutics

Biography

Biography: Manuela Stoicescu

Abstract

Present the clinical case of a patient 60 years old who was hospitalized in the first moment in the Psychiatric Department for psychical manifestations (extremely agitation, deliria and aggressively) but sudden, in a few hours, go in to a coma and for this reason was sent urgently in the Emergency Department and performed an Internal Medicine consultation. The patient was in Coma Glasgow 2; the history was impossible to take from the patient and was without family. At the objective examination he was pale, very thin, HR =78bates/min rhythmic, vesicular sound normal, BP=130/80mmHg, palpation of the abdomen relived a big formation (7/8cm) round, regular with high consistency in to the hypogastria area. Surprised were the results of the blood test relieved: creatinina=5,8mg/dl, urea=500mg/dl, K=6mEq/l, white blood cells=14 000/ mm³, neutrophiles=76%, lymphocytes=82%.Hb=10mg/dl, Ht=38%, Red blood cells=3millions/mm³.Except these results other blood tests were in normal range. So was a uremic coma. An abdominal echo was performed and showed a very big glob bladder (retention of the urine) with increase sedimentation inside of the bladder, prostate big, homogeneous with regular border, suggested an adenoma of the prostate and the both kidneys were small with irregular borders. Other organs were normal at the abdominal echo. Because of the presence of the glob bladder the patient was performed a urinary probing by urethra with a tube to eliminate the urine from the bladder. Unexpected in the tub not appeared urine. Was eliminated a very gross pus, white-yellowish, bed smell and sometimes blocked the tube, stopped elimination and must to be aspired with the needle and siring with serum to can be evacuated. The lab examination of this pus relieved increase leukocyte and lymphocytes level but unexpected the urine culture was negative (sterile) in context of this gross pus. For this reason was inseminated on Lowenstein Jensen culture medium and the result was surprise positive confirmed TB etiology of the infection and in conclusion the puss was in reality casseum. The final diagnosis was: tuberculosis of the kidney, TB infection, chronic renal failure, uremic coma with uremic encephalopathy, adenoma of the prostate, glob bladder. The therapy was: urinary probing for evacuation the urinary glob bladder, saline solution perfusion and glucose tampon with insulin for correction of hyperpotasemia, dialyses, tuberculostatic therapy with a good evolution of the patient.