What's the Take Home?
A 67-Year-Old Man With A Long History of Renal Abnormality and a Change in Hematocrit
Ronald N. Rubin, MD1,2—Series Editor
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
Rubin RN. A 67-year-old man with a long history of renal abnormality and a change in hematocrit. Consultant. 2020;60(10):20-21, 24. doi:10.25270/con.2020.10.00001
The author reports no relevant financial relationships.
Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 (firstname.lastname@example.org)
A 67-year-old man presented to the office for a general medical examination. He had no new or significant symptoms to report. He is a former smoker, having stopped about 10 years ago. The smoking has left him with mild to moderate chronic obstructive pulmonary disease with occasional wheezing but few problems with routine daily life—he is able to walk several blocks without dyspnea.
Of particular interest, 16 years ago, abdominal ultrasonography for gastrointestinal tract reasons had shown an incidental 2.3-cm renal mass. In accordance with the patient’s choice, the mass had been managed with no intervention other than serial imaging at 12- to 18-month intervals, the most recent of which had been 3 years ago and had shown the mass to have grown to 3.6 cm. He had not returned thereafter until now, and he has never experienced flank pain or hematuria.
At the current visit, examination of the lungs revealed bilateral expiratory wheezes, and flank and abdominal examination revealed no mass or pain. Office urinalysis results were negative for hematuria. Results of a biochemistry profile were totally within normal limits, including a serum creatinine level of 1.1 mg/dL, but results of a complete blood cell count (CBC) had changed since his studies of 3 years ago. His white blood cell count and platelet count were normal, but his hematocrit concentration had risen from the 43% to 44% range to 53%, with normal mean corpuscular volume and normal cell morphology on smear.