Nausea • vomiting • malaise • frequent urination • Dx?
- Kerkhof, Manon H. MD
- Scholten, Irma MD
> THE PATIENT
63-year-old multiparous woman
> SIGNS & SYMPTOMS
- Nausea
- Vomiting
- Frequent urination
> THE CASE
A 63-year-old multiparous woman visited her general practitioner because of nausea, vomiting, and general malaise. A proton pump inhibitor was prescribed, which temporarily relieved her symptoms. Two weeks later, however, her symptoms worsened and she was admitted to the hospital.
The patient's physical examination on admission was normal, but laboratory findings revealed severe renal failure with a creatinine level of 7.4 mg/dL (normal, 0.6-1.1 mg/dL), potassium level of 7.4 mmol/L (3.5-5 mmol/L), and a sodium level of 123 mmol/L (135-145 mmol/L). A renal ultrasound revealed severe bilateral hydronephrosis with hydroureteronephrosis caused by obstructive uropathy. A radiologist examined the patient and determined that she had a total uterine prolapse; the cervix was 11 cm outside of the vagina (FIGURE 1). Our patient's untreated pelvic organ prolapse (POP) had caused chronic renal failure. The patient was referred to a urogynecologist.
▪ Previous attempts at treatment. It appeared that our patient had POP for years and there had been a previous attempt to treat it with a pessary. However, because of an unpleasant experience at her initial appointment and because her biggest complaint (until recently) had been the need to urinate frequently, she had not returned for follow-up appointments.