Pearl: In a patient with an elevated creatinine, check the urine for protein. The urine needs to be adequately concentrated (look for a specific gravity of 1.020, or at least 1.015). Often, if there's a rise in the serum creatinine without protein in the urine the diagnosis turns out to be obstructive uropathy.
- Follow up with a renal ultrasound with post void residual (men) or a bladder scan with post void residual. The renal ultrasound may demonstrate hydronephrosis or an underlying cause for obstruction.
- This patient's cause likely due to her diabetes. The patient did have a history of diabetic neuropathy and another complication of diabetes is neurological involvement of the detrusor muscle of the bladder.