70-year-old male with a past medical history significant for nephrolithiasis, MI, CABG, CVA and DM presented to ED with 1 day history of worsening right flank pain, nausea, vomiting and chills. Seen one day earlier with CT demonstrating a stone in the right mid-ureter with associated moderate hydronephrosis with additional stones upper collecting systems bilaterally. BUN 19 CR 1.8 Lactate 3.4
Day of presentation:
1810: Urology consult. AKI with obstructive uropathy (creatinine increased from 1.5 to 1.8). Possible bilateral ureteral obstruction. Plan: OR.
1843: Operative procedure: Laser lithotripsy with removal of right distal ureteral stone, placement stent. No obstruction left ureter.
1851: H&P assessment: Obstructive uropathy. Plan: IV fluids, pain control, IV antibiotics, monitor renal function.
1931: Observation order placed
Day 1:
0440: CR 1.62, Lactate 1.4
1145: Urology note: Improving, tolerating PO. Was quite dehydrated: IV NS bolus x2, continue @ 150 ml/hr.
1214: Hospitalist note: 1 more day IV fluids then discharge home next day if creatinine better.
1731: Inpatient order placed
Day 2:
0400: CR 1.22
1105: Discharge to home
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