Incidental Discovery of Stage 4 CKD (9)

This 87 year old man has had a marked deterioration in his renal function.  6 years ago urea was 9.6 and creatinine 168.  Routine blood tests 2 weeks ago revealed urea 12.2, creatinine 244 and eGFR 22.  He has no symptoms and is feeling well. 

He does have a history of prostate problems and is currently awaiting urology assessment regarding symptoms of BPH. 

On examination pulse 70, BP 145/80, heart sounds 1+2, no peripheral or sacral oedema, chest clear with fine occasional respiratory crepitations in bases, abdomen soft and non-tender.  I have arranged an USS bladder and kidneys to exclude any high residual volumes or obstructive neuropathy.  Thank you for your advice on any further management you would recommend for this patient.

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Current Medication; Aspirin, Daktocort, Movicol

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You’ve already answered – or are in the process of answering – the first question – does he have urinary retention and obstruction? He is of the right age and sex and is known to have prostatic disease. He is otherwise well, with no causative medicines and no hypertension to treat. As he is well, I’m guessing that he has‚ “gone off” and has now plateaued but it would be important to repeat all these to make sure this isn’t an acute renal failure that’s getting worse. If he demonstrates blood ++++ and/or protein ++++ we would be concerned.

Might I suggest that if his scan is normal, and especially if his U&E are getting worse, you ask us to see him? I’m hopeful however that this is good old obstruction which will improve with catheterisation. If his scan is positive, I’d have thought that the latter should be done without delay.


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