A 73-year-old man collapses at home following a stroke. He is found 24 hours later, still lying on the floor. On admission to hospital he appears only mildly dehydrated but is in acute renal failure. He is treated with i.v. fluids but remains oliguric and his renal function continues to deteriorate. Dipstick urinalysis is strongly positive for blood but microscopy reveals no red cells. What is the most likely diagnosis?
- Renal calculus
- Urinary sepsis
- Rapidly progressive glomerulonephritis
- Renal infarction
- Rhabdomyolysis
All of the options listed could conceivably account for deteriorating renal function accompanied by dipstick-positive haematuria, but the absence of red cells on microscopy is characteristic of myoglobinuria occurring as a consequence of rapid muscle breakdown. This patient is at risk of rhabdomyolysis from having lain on the floor for 24 hours.
More on Interpretation of dipstick-positive haematuria (p. 479)
More on Interpretation of dipstick-positive haematuria (p. 479)
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