Table 1.
Laboratory findings on the first attendance and on perirenal fluid drainage
| On the first attendance | On perirenal fluid drainage | ||||||
|---|---|---|---|---|---|---|---|
| <Blood test> | <Blood test> | <Perirenal fluid component> | |||||
| Blood cell count | Coagulation | Na | 141 mEq/L | Specific gravity | 1.020 | ||
| WBC | 8450/μL | PT-INR | 1.01 | K | 4.5 mEq/L | pH | 8.0 |
| RBC | 3.66×106/μL | APTT | 27.1 s | Cl | 104 mEq/L | Protein | (2+) 3.0 g/dL |
| Hb | 10.3 g/dL | Fibrinogen | 701 mg/dL | Cre | 1.50 mg/dL | Occult blood | (3+) |
| Hct | 33.7 % | Endocrine | BUN | 25.1 mg/dL | RBC | >100/HPF | |
| Plt | 29.4×104/μL | Plasma renin activity | 5.6 ng/mL/h | <Urinalysis> | WBC | 30-49/HPF | |
| Blood chemistry | Aldosterone | 282 pg/mL | Specific gravity | 1.014 | Cast | Negative | |
| CRP | 0.28 mg/dL | ACTH | 12.3 pg/mL | pH | 6.0 | Bacteria | Negative |
| TP | 7.5 g/dL | Cortisol | 11.5 µg/dL | Protein | (2+) 0.127 g/dL | Atypical cell | Negative |
| Alb | 4.0 g/dL | Immunochemistry | Occult blood | (3+) | Na | 140 mEq/L | |
| AST | 10 U/L | ANA | ×40 titer | RBC | >100/HPF | K | 3.9 mEq/L |
| ALT | 6 U/L | MPO-ANCA | Negative | WBC | 30–49/HPF | Cl | 108 mEq/L |
| LDH | 299 U/L | PR3-ANCA | Negative | Cast | Negative | Cre | 1.46 mg/dL |
| T-Bil | 0.5 mg/dL | Anti-GBM antibody | Negative | Na | 107 mEq/L | UN | 24.0 mg/dL |
| BUN | 30.8 mg/dL | <Urinalysis> | K | 27.6 mEq/L | LDH | 679 U/L | |
| Cre | 4.01 mg/dL | Metanephrine | 0.121 mg/gCre | Cl | 108 mEq/L | ||
| Na | 142 mEq/L | Normetanephrine | 0.225 mg/gCre | Cre | 78.9 mg/dL | ||
| K | 5.0 mEq/L | Cre | 57.9 mg/dL | UN | 542 mg/dL | ||
| Cl | 107 mEq/L | ||||||
Renal dysfunction with elevated plasma renin activity and serum aldosterone was observed on the first attendance; however, there were no laboratory findings suggestive of thrombotic microangiopathy, pheochromocytoma, coagulopathy, autoimmune disease, perirenal tumor invasion, or infection. On perirenal fluid drainage, examination of the fluid revealed almost the same levels of electrolytes, urea nitrogen, and creatinine as those in the blood and an elevated level of lactate dehydrogenase with many red and white blood cells, suggesting that the fluid was hemolyzed blood rather than urine
ACTH adrenocorticotropic hormone, ANA antinuclear antibody, MPO myeloperoxidase, PR3 proteinase 3, ANCA anti-neutrophil cytoplasmic antibody, GBM glomerular basement membrane