Pulmonary Nodule\Renal Failure\Cerebral Ischemia\Urinary Tract Stone\Death

(The medical records below were provided by the patient’s family. Some photographs were taken from suboptimal angles or are not fully captured, particularly at the junctions between consecutive pages. In addition, the scanned images may contain missing characters, distortions, or other artifacts.) Male, 74 years old Discharge Summary (Scanned document; some characters may be illegible) Department: Nephrology Admission Date: July 20, 2022 Discharge Date: July 28, 2022 Outpatient Diagnosis: Chronic Kidney Disease, Stage 5 Admission Diagnosis: Chronic renal insufficiency; renal anemia; metabolic acidosis; sinus bradycardia; first-degree atrioventricular block; right bundle branch block; post-appendectomy status Discharge Diagnosis: Acute exacerbation of chronic renal insufficiency; renal anemia; metabolic acidosis; hyperuricemia; sinus bradycardia; first-degree atrioventricular block; complete right bundle branch block; aortic valve calcification (focal); right kidney stones; simple right renal cyst; pulmonary nodule (TI-RADS Class 3); left thyroid nodule (TI-RADS Class 2); abnormal pulmonary diagnostic imaging (pulmonary nodules); bilateral lower extremity atherosclerosis; benign prostatic hyperplasia; lacunar cerebral infarction; gastritis; post-appendectomy status; upper respiratory tract infection Admission Status: The patient was admitted due to "increased urinary foam for 10 years, fatigue and decreased appetite for 1 month." Physical examination: T: 36.1℃, P: 46 bpm, BP: 91/45 mmHg. The patient was conscious and breathing steadily with good mental status. Skin and sclera were without jaundice; no enlargement of superficial lymph nodes. Breath sounds in both lungs were clear, with no obvious moist or dry rales. HR 46 bpm, regular rhythm, no murmurs or pericardial friction rub. Abdomen was flat and soft, no tenderness or rebound tenderness; liver and spleen were not palpable under the costal margin. No edema in lower extremities. Neurological status: negative. Key Laboratory Results: 【24h Urine Protein】July 23, 24-hour urine protein 300.4 mg/24h ↑; July 25, 24-hour urine protein 371.8 mg/24h ↑. 【Renal Function】July 20, Urea 16.9 mmol/L ↑, Creatinine 352 μmol/L ↑, Uric acid 575 μmol/L ↑, Cr 14; July 22, Urea 14.00 mmol/L ↑, Creatinine 282.0 μmol/L ↑, Uric acid 463.00 μmol/L ↑, EPI Cr 18, eGFR-MDRD 19, Cystatin C 2.75 mg/L ↑; July 26, Urea 13.60 mmol/L ↑, Creatinine 237.0 μmol/L ↑, Uric acid 328.00 μmol/L, eGFR-EPI Cr 22, eGFR-MDRD 23, Cystatin C 2.62 mg/L ↑. 【Urine ACR】July 21, urine albumin-creatinine ratio 15.7 mg/g; July 22, 15.6 mg/g; July 23, 13.6 mg/g. 【Urine Microprotein】July 21, microalbumin 16.50 μg/ml, immunoglobulin G 21.00 mg/L ↑, albumin <2.3 mg/L, light chain Kappa 176.0 mg/L ↑, light chain Lambda 70.4 mg/L ↑, α₁-microglobulin 25.0 mg/L ↑, β₂-microglobulin 7.26 mg/L ↑; July 22, microalbumin 14.30 μg/ml, immunoglobulin G 7.00 mg/L, transferrin <2.3 mg/L, α₁-microglobulin 97.20 mg/L ↑, β₂-microglobulin 22.30 mg/L ↑. 【Urine Routine】July 20, protein 1+ ↑, WBC 1.8/HP, RBC 0.3/HP; July 21, protein 1+ ↑, WBC 6.8/HP, RBC 0.0/HP; July 22, protein ±, WBC 0.4/HP, RBC 0.2/HP. 【Blood Routine】July 20, WBC 5.63 × 10⁹/L, neutrophil percentage 60.9%, hemoglobin 86 g/L ↓, platelets 153 × 10⁹/L; July 26, WBC 5.85 × 10⁹/L, neutrophil percentage 57.7%, hemoglobin 96 g/L ↓, platelets 112 × 10⁹/L ↓. 【Reticulocytes】July 20, reticulocyte count 0.053 × 10¹²/L, reticulocyte percentage 1.54%, immature RET fraction 6.4%, low fluorescence reticulocyte 93.6%, medium fluorescence reticulocyte 5.6%, high fluorescence reticulocyte 0.8%, reticulocyte hemoglobin content 31.3 pg, nucleated RBC percentage 0.0/100 WBC, nucleated RBC absolute value 0.00 × 10⁹/L. 【Coagulation (Emergency) + Coagulation Series】July 20, prothrombin time 12.90 s ↑, INR 1.15, fibrinogen 2.66 g/L, activated partial thromboplastin time 31.1 s, thrombin time 17.9 s, D-dimer 1.96 mg/L ↑, fibrin degradation products 11.50 μg/ml ↑; July 26, D-dimer 0.70 DDU μg/ml ↑, fibrin degradation products 5.40 μg/ml ↑. 【Coagulation Factor Activity (8 tests)】July 20, factor II 74.9%, factor V 153.3% ↑, factor VII 136.1% ↑, factor VIII 192.2% ↑, factor IX 95.8%, factor X 63.2% ↓, factor XI 79.5%, factor XII 56.0% ↓. 【Liver Function】July 20, ALT 16 U/L, AST 28 U/L, albumin 38.0 g/L; July 21, ALT 13 U/L, AST 20 U/L, albumin 29.4 g/L ↓; July 26, ALT 15 U/L, AST 21 U/L, albumin 26.2 g/L ↓. 【Amylase】July 20, 81 U/L. 【C-Reactive Protein】July 20, <0.50 mg/L; July 26, 16.96 mg/L ↑. 【ESR】July 20, 29 mm/h ↑. 【Procalcitonin】July 20, 0.052 ng/ml; July 26, 0.103 ng/ml. 【Blood Gas Analysis】July 20, pH 7.167 ↓↓, bicarbonate 15.9 mmol/L ↓; July 20, pH 7.273 ↓, bicarbonate 21.5 mmol/L; July 26, pH 7.320 ↓, bicarbonate 24.7 mmol/L. 【Electrolytes】July 20, potassium 3.9 mmol/L, sodium 138 mmol/L, chloride 111 mmol/L ↑; July 27, 4.29 mmol/L, sodium 137.00 mmol/L, chloride 104.50 mmol/L; July 22, potassium 4.18 mmol/L, sodium 137.0 mmol/L, chloride 103.50 mmol/L. 【Glucose Metabolism】July 21, fasting glucose 3.77 mmol/L ↓; 2-hour postprandial 7.73 mmol/L; HbA1c 5.6%. 【Lipids】July 21, total cholesterol 2.36 mmol/L, triglycerides 0.70 mmol/L, HDL 0.80 mmol/L ↓, LDL 1.13 mmol/L. 【Iron Metabolism】July 21, serum iron 9.5 μmol/L ↓, TIBC 31.20 μmol/L ↓, ferritin 155.60 ng/ml. 【Folic Acid, B12】July 21, folic acid 18.5 μg/L, vitamin B12 539.0 pg/ml. 【Calcium, Phosphorus, Magnesium, PTH】July 21, calcium 2.01 mmol/L ↓, phosphorus 1.24 mmol/L, magnesium 0.86 mmol/L, PTH 202.3 pg/ml ↑; July 26, calcium 1.89 mmol/L ↓, phosphorus 1.21 mmol/L, PTH 195.2 pg/ml ↑. 【25-OH-D3】July 21, 25-hydroxy vitamin D 16.71 ng/ml ↓; July 22, 25-hydroxy vitamin D3 11.4 ng/ml, 25-hydroxy vitamin D2+D3 12.8 ng/ml ↓, 25-hydroxy vitamin D2 1.4 ng/ml. 【Troponin】July 20, Troponin I 0.04 ng/ml; July 26, Troponin I 0.03 ng/ml. 【BNP】July 20, 103.0 pg/ml ↑; July 26, 304.0 pg/ml ↑. 【NT-proBNP】July 20, 1039.00 pg/ml ↑. 【Creatine Kinase】July 20, 68 U/L; July 26, 61 U/L. 【Hepatitis/HIV/TPPA】July 21, HBsAg 0.42 COI, anti-HBs 109.00 mIU/ml ↑, anti-HBc 0.009 COI ↑, HBeAg 0.08 COI, anti-HBe 0.95 COI ↑, HCV antibody 0.04 S/CO, HIV Ag/Ab 0.03 COI; July 22, syphilis TRUST negative, syphilis confirmation test negative, HBV-DNA <20.00 IU/mL; July 23, HCV-RNA <15.00 IU/mL. 【Hepatitis E Antibody】July 21, anti-HEV IgG negative, anti-HEV IgM negative. 【Interleukins】July 21, IL-1β (luminescence) 5.33 pg/ml ↑, IL-2R (luminescence) 1134.00 U/mL ↑, IL-6 (luminescence) 7.82 pg/ml ↑, IL-8 (luminescence) 40.30 pg/ml, IL-10 (luminescence) <5.00 pg/mL. 【Treg】July 21, regulatory T cells (CD3+CD4+CD25+CD127-) 7.00% ↓. 【CD20】July 21, CD20+ lymphocyte percentage (CD45+CD3-CD20+/LYM%) 9.90%. 【ST2 (Emergency)】July 20, soluble growth stimulation expressed gene 2 protein 44.8 ng/ml ↑. 【Heparin-Binding Protein (Emergency)】July 20, 58.85 ng/ml ↑. 【Thromboelastography (standard)】July 20, standard test, reaction time (R) 7.70 min, K time 1.80 min, alpha angle 64.40 deg, maximum amplitude (MA) 54.00 mm, coagulation index -2.00, predicted lysis 1.20%, lysis at 30 min 0.20%, coagulation time 23.80 min, clot strength 5871.40 d/sc; TEG factor, fibrinogen, platelet function, and fibrinolysis system all normal. 【Lymphocyte Subsets】July 21, B cells (CD3-CD19+) 10.9%, T cells (CD3+) 75.4%, Th cells (CD3+CD4+) 49.2% ↑, Ts cells (CD3+CD8+) 26.2%, CD4/CD8 ratio 1.88, NK cells (CD16+CD56+) 9.5%, total lymphocytes (CD45+) 1.63 × 10⁹/L, B cells absolute 177.7 cells/uL, T cells absolute 1229.0 cells/uL, Th absolute 802.0 cells/uL, Ts absolute 427.1 cells/uL, NK absolute 154.9 cells/uL ↓. 【Cytokines】July 20, IL-1β 2.14 pg/ml, IL-4 3.23 pg/ml ↑, IL-5 1.39 pg/ml, IL-6 5.90 pg/ml ↑, IL-10 12.28 pg/ml, IL-10 (second) 3.83 pg/ml, IL-12p70 3.89 pg/ml ↑, IL-17A 8.45 pg/ml, TNF-α 3.16 pg/ml, IFN-α 1.97 pg/ml, IFN-γ 2.95 pg/ml. 【Interleukin (5 items)】July 21, IL-1β (luminescence) 5.33 pg/ml, IL-2R (luminescence) 1134.00 U/mL, IL-6 (luminescence) 7.82 pg/ml ↑, IL-8 (luminescence) 40.30 pg/ml, IL-10 (luminescence) <5.00 pg/mL. 【Thyroid Function】July 21, free T3 2.32 pmol/L ↓, free T4 14.80 pmol/L, TSH 3.260 mIU/L, TGAb 203.00 IU/ml ↑, TPOAb 65.70 IU/ml ↑, TRAb <0.80 IU/L. 【Tumor Markers】July 21, AFP 1.79 ng/mL, CEA 4.25 ng/ml, CA19-9 20.90 U/ml, CA50 15.00 U/ml, CA242 4.68 U/ml, CA125 3.65 U/ml, CA724 <1.50 U/ml, CYFRA 21-1 3.98 ng/ml ↑, SCC 5.04 ng/ml ↑, NSE 9.52 ng/ml, total PSA 0.25 ng/ml, free PSA 0.13 ng/ml, f/t PSA 0.52. 【Complement】July 21, C3 0.54 g/L ↓, C4 0.31 g/L; July 26, C3 0.45 g/L ↓, C4 0.25 g/L. 【Immunoglobulin Light Chains】July 21, Kappa 7.94 g/L ↑, Lambda 4.55 g/L ↑, ratio 1.745; July 22, Kappa 6.95 g/L ↑, Lambda 3.08 g/L ↑, ratio 2.256. 【Immunoglobulin】July 21, IgG 30.60 g/L ↑, IgA 2.06 g/L, IgM 0.49 g/L, IgG1 13.80 g/L, IgG2 7.33 g/L, IgG3 0.61 g/L, IgG4 1.900 g/L ↑, IgE 365.00 IU/ml ↑; July 26, IgG 24.90 g/L ↑, IgA 1.55 g/L, IgM 0.49 g/L, IgG1 10.60 g/L ↑, IgG2 6.72 g/L, IgG3 0.445 g/L, IgG4 14.400 g/L ↑. 【Autoantibodies (New 3) + Anti-beta2】July 22, all negative or normal ranges, including anti-dsDNA (ELISA) 28.94 IU/ml, anti-nucleosome 0.08, Sm 1.7, Sm 4.4, Ro52 1.2, Ro60 3.3, SSB/La 1.3, Jo-1 3.5, Scl-70 1.2, ribosomal P 0.1, histone 0.5, nucleosome B 0.3, PM-Scl 3.4, PCNA 1.2, peri-nuclear 1.0, anti-cardiolipin IgA 0.57 APL/ml, IgM 0.64 MPL/ml, IgG 2.41 GPL/ml, anti-Beta2GP1 IgG 0.10, IgM 0.41. 【Arthritis Profile】July 22, glucose-6-phosphate isomerase 0.01, anti-CCP 1.1, RF-IgG 2.7 U/mL, RF-IgA 0.1 U/mL, RF-IgM 1.8 IU/mL. 【Anti-GBM (Fluorescence)】July 21, MPO <0.20 AI, anti-GBM <0.20 AI, PR3 <0.20 AI. 【Neutrophil Antibodies (4 items)】July 22, P-ANCA weakly positive ↑, C-ANCA negative, atypical ANCA negative, anti-MPO 0.12, anti-PR3 0.15. 【Anti-GBM Assay】July 26, anti-GBM IgG 0.07 INDEX. 【Anti-PLA2R IgG】July 26, 0.06 S/CO. 【Bence-Jones Protein】July 21, negative. 【Urine Immunofixation】July 21, IgG, IgA, IgM, kappa, and lambda bands negative; no monoclonal bands detected. 【Serum Protein Electrophoresis】July 22, albumin 44.9% ↓, α₁ 3.5%, α₂ 6.4% ↓, β₁ 4.2% ↓, β₂ 4.40%, γ 36.6% ↑. 【Urine Light Chains】July 21, Kappa 178.0 mg/L ↑, Lambda 70.5 mg/L ↑; re-check: Kappa 176.0 mg/L ↑, Lambda 70.4 mg/L ↑. 【NGAL】July 21, 502.10 ng/ml ↑; re-check: 494.40 ng/ml ↑. 【Urine Enzyme (Biochemical 2)】July 21, N-acetyl-β-D-glucosaminidase 7.20 U/L, retinol-binding protein 19.95 mg/L ↑. 【Anti-dsDNA】July 21, 11.68 IU/ml ↑. 【EBV/CMV】July 21, CMV-IgG >180 U/mL ↑, CMV-IgM <5 U/mL; DNA-EBV <400 copies/ml, DNA-CMV <400 copies/ml; BKV-DNA <2000 copies/ml, JCV-DNA <2000 copies/ml. 【TB/Mycoplasma】July 21, TB antibody negative, Mycoplasma pneumoniae antibody negative. 【T-spot】July 22, negative, antigen A (ESAT-6) 1.00 count, antigen B (CFP 10) 0.00 count. 【Fungal/Endotoxin】July 22, (1,3)-β-D-glucan 37.5 pg/ml, Cryptococcus latex agglutination negative, G- bacteria lipopolysaccharide <0.030 pg/ml. 【GM Test】July 22, 0.31 S/CO. 【EBV (ELISA)】July 22, VCA-IgG 4.20 S/CO ↑, VCA-IgM 0.05 S/CO, early antigen IgG 0.10 S/CO, nuclear antigen IgG 4.17 S/CO ↑, VCA-IgG avidity 0.77 (high avidity). 【Respiratory Pathogens (13 types)】July 27, Influenza A, H1N1, H3N2, parainfluenza, metapneumovirus, Mycoplasma, RSV, rhinovirus, bocavirus, chlamydia, Influenza B, coronavirus—all negative. 【Stool Routine/Occult Blood】July 21, occult blood weakly positive ↑, transferrin negative ↑. 【Parasites】July 21, stool parasites negative. Imaging Reports: July 20, Echocardiography: Aortic valve focal calcification; HR 45 bpm; LVEF 59%. July 20, Thyroid/Neck/Carotid Ultrasound: Bilateral carotid intimal thickening with multiple plaques; increased carotid IMT; bilateral CCA resistance index increased; right thyroid solid nodule (TI-RADS 3); left thyroid cystic nodule (TI-RADS 2); no abnormalities in parathyroid area or lymph nodes. Innominate artery bifurcation wall plaque formed. July 20, Lower Extremity Ultrasound: Bilateral arterial intima rough with plaques; bilateral veins patent. July 20, Abdominal Ultrasound (Liver/Gallbladder/Pancreas/Spleen/Kidney/Ureter/Bladder/Prostate/Renal Artery/Vein): Gallbladder wall calcification; right kidney damage with stones/crystals; left kidney not clearly visualized; right renal artery resistance index increased; prostate full with calcification; bladder filling poor, inner wall unclear. Liver, pancreas, spleen normal. July 20, Bedside ECG: 1. Sinus bradycardia; 2. First-degree AV block; 3. Complete right bundle branch block; 4. ST-segment changes (II, III, aVF level extension). July 21, Chest HRCT: Scattered spots in both lungs, partial ground-glass opacities; fibrous streaks; pulmonary bullae; local pleural thickening; aortic and coronary sclerosis. July 22, Ureter/Kidney CT: Left kidney atrophy, right kidney compensatory enlargement; multiple right kidney stones, possible multiple cysts; possible small bowel obstruction; retroperitoneal lymphadenopathy; bilateral inguinal lymphadenopathy; slight pelvic effusion; enlarged prostate. July 22, Lymph Node Ultrasound (Submandibular/Neck/Chin/Supraclavicular/Axillary/Inguinal): Bilateral inguinal lymphadenopathy present; no enlarged lymph nodes in axillary, neck, submandibular, or supraclavicular regions. July 26, PET/CT: 1. Small nodule in middle lobe of right lung with mild FDG uptake (follow-up recommended); scattered spots and ground-glass changes in both lungs; scattered fibrous streaks; left upper lobe bulla; inflammatory hyperplasia of mediastinal and hilar lymph nodes. 2. Left renal atrophy, multiple right renal stones and cysts, possible hemorrhage. 3. Possible cholecystitis; pancreatic atrophy (suggest US); inflammation in right abdomen (small intestine/colon); retroperitoneal/inguinal lymphadenopathy; pelvic effusion. 4. Prostate hyperplasia. Generalized subcutaneous edema. Right shoulder peri-muscular inflammation. 5. Bilateral basal ganglia infarctions; age-related brain changes. July 25, Dynamic ECG (Holter): Sinus rhythm, 71,749 total beats; average HR 50 bpm; max HR 75 bpm; min HR 38 bpm; max R-R interval 2.23 s (8 instances of R-R > 2s, all due to blocked PACs); 0 PVCs. No ischemic ST-T changes. Complete right bundle branch block present. July 27, Cardiology Consultation: No pauses > 3s; pauses due to blocked PACs. Recommendations: Follow-up with primary physician; pacemaker if syncope or pauses > 3s occur. Treatment Course: After admission, the patient underwent comprehensive evaluations. Management included low-salt, high-quality low-protein soft diet, sodium bicarbonate to correct acidosis, polymer adsorbent for intestinal detox, and febuxostat for uric acid. HR was approximately 50 bpm; Holter showed sinus bradycardia, max R-R 2.23 s. Cardiology recommended close outpatient follow-up and monitoring for syncope/pauses > 3s for potential pacemaker implantation. Renal function decreased significantly during hospitalization. The patient remained stable without subjective discomfort, urine output ~1400 ml/day, and was discharged for follow-up. PET/CT Examination Report Radiopharmaceutical: 18F-FDG Administration: Intravenous injection Examined regions: Whole body + brain Examination date: July 26, 2022 Fasting blood glucose: 4.1 mmol/L Clinical diagnosis: Elevated TM Brief medical history: Foamy urine for 10 years, fatigue and decreased appetite for 1 month. Admitted to the nephrology department on July 22. CYFRA21-1 was 3.98, squamous cell carcinoma antigen 5.04. Abdominal CT showed left kidney atrophy, compensatory enlargement of the right kidney, multiple stones and possible cysts in the right kidney, possible small bowel obstruction, multiple enlarged retroperitoneal and bilateral inguinal lymph nodes. Chest CT revealed scattered nodular opacities in both lungs, some ground-glass opacities. PET/CT was performed to rule out tumor. Imaging findings: After fasting, the radiopharmaceutical was injected intravenously, followed by static acquisition of whole-body and brain PET/CT images. Image quality was clear. The bilateral thoracic cavities were symmetrical with a midline trachea. Lung markings were clear. A cystic lucency was noted in the left upper lobe. A small nodule measuring approximately 6 × 4 mm was seen in the right middle lobe, with FDG uptake slightly higher than background lung tissue (SUVmax = 0.7). Additional scattered nodular shadows and some ground-glass densities were present in both lungs, along with fibrotic strands; FDG uptake was not significantly abnormal. Lymph nodes were visible in the mediastinum (para-aortic, paracaval, subcarinal, and bilateral hilar regions) with increased FDG uptake (SUVmax 2.5–3.2). Both kidneys were in normal position. The left kidney was atrophic; the right kidney was relatively enlarged and contained multiple cystic or slightly hyperdense nodules with clear borders and photopenic FDG uptake. Multiple dense shadows were seen in the renal pelvis. FDG uptake in the renal parenchyma was physiologically decreased. The gallbladder was normal in shape with mild wall thickening and no significant FDG uptake. The pancreas was atrophic with no significant FDG uptake. Increased FDG uptake (SUVmax 5.3–8.6) was noted in portions of the small bowel in the right abdomen, hepatic flexure, descending colon, sigmoid colon, and rectum; CT showed no obvious bowel wall thickening. Multiple small para-aortic lymph nodes showed no significant FDG abnormality. Multiple lymph nodes were present in the bilateral inguinal regions, some enlarged (largest on the left measuring approximately 18 mm) with mildly increased FDG uptake (SUVmax 2.0). Pelvic fluid collection was present. The prostate was enlarged with no abnormal FDG uptake within the gland. Subcutaneous fat planes in the back, abdomen, pelvis, and bilateral lower limbs were blurred with multiple linear shadows and no significant FDG abnormality. Patchy increased FDG uptake was seen around the right shoulder joint muscles (SUVmax 3.3). The nasopharynx, parotid and submandibular glands were unremarkable. The thyroid lobes were normal in size and density with no abnormal FDG uptake. Physiologic FDG uptake was present in the tonsils and pharynx. The trachea was midline. Bilateral piriform sinuses were symmetrical. No enlarged cervical lymph nodes or abnormal FDG uptake. No pleural thickening or effusion. No significant physiologic cardiac FDG uptake. The stomach was well distended with no wall thickening or abnormal FDG uptake. The liver, spleen, and adrenal glands were normal. Physiologic FDG uptake was seen in the liver, pancreas, and spleen. No enlarged iliac lymph nodes. Physiologic FDG uptake in the ureters and bladder. No abnormal FDG uptake in the skeleton. Multiple small patchy low-density shadows were present in the bilateral basal ganglia with no significant FDG abnormality. No other intracranial abnormal high- or low-density lesions. Ventricles, sulci, and cisterns were prominent consistent with age-related changes. Midline structures were not shifted. Cortical radiotracer distribution was symmetrical. No abnormal uptake or defects in the frontal, parietal, temporal, occipital, insular, or cingulate regions. Thalami and cerebellar hemispheres showed symmetrical distribution. Examination conclusions: 1. Small nodule in the right middle lobe with mildly increased FDG uptake; close follow-up recommended. Scattered nodular and ground-glass opacities in both lungs; follow-up recommended. Fibrotic strands in both lungs. Pulmonary bulla in the left upper lobe. Inflammatory hyperplasia of mediastinal and bilateral hilar lymph nodes. 2. Left kidney atrophy, multiple stones and cysts in the right kidney, some possibly with hemorrhage. 3. Possible cholecystitis. Pancreatic atrophy; ultrasound recommended. Possible inflammation or physiologic uptake in portions of the small bowel, hepatic flexure, descending colon, sigmoid colon, and rectum. Multiple small para-aortic lymph nodes and multiple inguinal lymph nodes, some enlarged; follow-up recommended. Pelvic fluid collection. 4. Prostatic hyperplasia. Generalized subcutaneous edema. Inflammation around the right shoulder joint muscles. 5. Infarcts in the bilateral basal ganglia; age-related brain changes. Report date: July 26, 2022 Chest CT Scan Report Department: Respiratory Medicine Examination time: January 25, 2023 13:33:22 Clinical impression: Upper respiratory infection with cough, acute bronchitis Requested study: Chest (bilateral lungs, mediastinum, chest wall), non-contrast Examination: Chest CT plain scan with MPR coronal and oblique reconstructions, tracheal C reconstruction, and MPR reconstructions. Radiologic findings: Bilateral thoracic cavities symmetrical. Lung markings clear. Patchy consolidation in the right lower lobe with heterogeneous density and slightly ill-defined margins. Solid nodule in the lateral segment of the right middle lobe (IM202), average diameter approximately 6 mm. No obvious abnormalities in the trachea or bronchi; no compression. No mediastinal masses or enlarged lymph nodes. Calcification of the aorta and aortic valve. Bilateral pleural effusions. Radiologic diagnosis: Patchy opacity in the right lower lobe, suspicious for mass; contrast-enhanced study recommended. Solid small nodule in the right middle lobe; 12-month follow-up advised. Aortic and aortic valve calcification. Report time: January 25, 2023 16:22 Verification time: January 25, 2023 Laboratory charges: $1,268.00 January 27, 2023 10:33 Clinical Laboratory Report Clinical diagnosis: Pulmonary shadow Specimen: Serum Test results (selected): Salivary acid sugar chain antigen: 133.51 (105.3–401.2 U/ml) Glucose: 5.3 (4.3–5.9 mmol/L) Urea: 12.1 ↑ (3.6–9.5 mmol/L) Creatinine: 209 ↑ (57–111 μmol/L) eGFR (modified MDRD): 26.15 ↓ (>90 ml/min/1.73 m²) eGFR (CKD-EPI CYSC): 21.62 ↓ (>90 ml/min/1.73 m²) Uric acid: 430 ↑ (208–428 μmol/L) Cystatin C: 2.76 ↑ (0.56–1.15 mg/L) Total protein: 81.8 (65.0–85.0 g/L) Albumin: 29.5 ↓ (40.0–55.0 g/L) Globulin: 52.3 ↑ (20.0–40.0 g/L) A/G ratio: 0.6 ↓ (1.2–2.4) Total cholesterol: 3.43 (0.00–5.18 mmol/L) Tumor markers: CEA: 4.96 (0.00–5.00 ng/ml) SCC: 2.30 ↑ (0.00–1.50 ng/ml) NSE: 5.29 (0.00–17.00 ng/ml) CYFRA21-1: 3.82 ↑ (0.00–3.30 ng/ml) PROGRP: 77.38 ↑ (<65.00 pg/ml) February 10, 2023 Previous chest CT (Dec 2022): pulmonary nodule PET/CT Jan 25, 2023: right hilar nodule PET/CT Jul 6, 2022: right lower lobe nodule, hilar nodule PET/CT Jul 21, 2022 Laboratory: BUN 12.1 ↑, Cr 209 ↑ Orders: Chest CT; blood routine + CRP + SAA + ESR Medications: none Recommendation: Outpatient management Visit date: February 10, 2023 Chief complaint: Pulmonary shadow History: Pulmonary shadow Physical examination: Alert, clear breath sounds bilaterally, no rales or wheezes, regular rhythm. Diagnosis: Pulmonary shadow Plan: Contrast-enhanced chest CT with 3D reconstruction; blood routine + CRP + SAA + ESR Blood routine, CRP, SAA, ESR results (Feb 10, 2023): WBC 11.2 × 10⁹/L ↑ Neutrophils 8.6 × 10⁹/L (76.5%) ↑ Lymphocytes 1.6 × 10⁹/L (14.4%) ↓ Hemoglobin 97 g/L ↓ Hematocrit 29.6% ↓ Platelets 199 × 10⁹/L CRP 40.75 mg/L ↑ SAA 109.83 mg/L ↑ ESR 99 mm/h ↑ CT report (February 13, 2023): Right middle and lower lobe soft-tissue density mass with internal low-density areas and minimal gas; heterogeneous enhancement after contrast, surrounding patchy infiltrates. Scattered patchy, linear, and tiny nodular opacities in both lungs. Enlarged right hilar and mediastinal lymph nodes. Local pleural thickening bilaterally. Right pleural effusion. Left kidney small. Conclusion: Right middle-lower lobe soft-tissue density shadow; infection versus tumor; recheck after antibiotics. Chronic inflammation in both lungs. Enlarged right hilar and mediastinal lymph nodes. Bilateral pleural thickening. Right pleural effusion. Left kidney atrophy. Follow-up recommended. Blood routine + CRP + ESR (February 23, 2023): CRP 9.51 mg/L ESR 97 mm/h ↑ Hemoglobin 100 g/L ↓ Other parameters showed persistent mild anemia and inflammation. CT (February 23, 2023): Right middle-lower lobe soft-tissue density shadow, smaller than before, with enlarged internal cavity. Surrounding patchy infiltrates. Scattered chronic changes in both lungs. Enlarged right hilar and mediastinal lymph nodes. Bilateral pleural thickening. Right pleural effusion. Left kidney atrophy. Conclusion: Right middle-lower lobe lesion improved in size but cavity enlarged; clinical correlation needed. Follow-up recommended. Visit date: March 3, 2023 Respiratory Medicine Chief complaint: Follow-up Physical examination: Alert, clear breath sounds, no adventitious sounds. Diagnosis: Pneumonia Radiology Report Examination site: Thin-slice chest CT scan Examination: Non-contrast scan Examination date: April 8, 2023, 10:24:29 Report date: April 8, 2023, 11:15:52 Findings The chest is symmetric. Increased lung markings are noted bilaterally, with normal radiolucency. Patchy consolidation and hazy opacities with bronchiectasis are seen in the right middle and lower lobes. A 5 mm nodule is present in the right middle lobe. No enlarged lymph nodes are visible in the mediastinum. The heart shadow and great vessels appear normal. Partial calcification is noted in the aortic and coronary artery walls. No obvious free fluid is seen in either pleural cavity. Clinical Diagnosis Consolidation and infection with bronchiectasis in the right middle and lower lobes; small nodule in the right middle lobe. Partial calcification of the aortic and coronary artery walls. Additional finding: Right kidney stone; left kidney not visualized. Discharge Summary (scanned copy, some characters may be missing) Department: Respiratory Medicine Ward Visit date: April 8, 2023 Admission date: April 8, 2023 Discharge date: April 17, 2023 Outpatient/Emergency Diagnosis 1. Pulmonary shadow; nature to be determined 2. Grade 1 hypertension 3. Chronic renal insufficiency; CKD stage 3 4. Hyperuricemia Admission Diagnosis 1. Pulmonary shadow; nature to be determined 2. Grade 1 hypertension 3. Chronic renal insufficiency; CKD stage 3 4. Hyperuricemia Discharge Diagnosis 1. Pulmonary shadow; nature to be determined 2. Grade 1 hypertension 3. Chronic renal insufficiency; CKD stage 3 4. Hyperuricemia 5. Vertebral artery occlusion 6. Low T3 syndrome 7. Sinus bradycardia Main Symptoms and Signs on Admission The patient, a 75-year-old male, was admitted because of “right lung shadow discovered more than 2 months earlier.” Physical examination: Alert and oriented, breathing comfortably. Blood pressure 152/74 mmHg. No lip cyanosis. Coarse breath sounds in both lungs, with no dry or moist rales. Heart rate 51 beats/min, regular rhythm. Soft abdomen, no tenderness or rebound. No pitting edema in lower limbs. Finger oxygen saturation 98% on room air. Key Laboratory Results April 8, 13:49:47 (urgent) Arterial blood gas: pH 7.27↓, pCO₂ 4.7 kPa, pO₂ 14.4 kPa↑, Ca⁺ 1.06 mmol/L↓, Glu 5.6 mmol/L↑, Lac 1.3 mmol/L, Hct 44%, HCO₃⁻ 16.1 mmol/L↓, TCO₂ 17.2 mmol/L↓, BE(B) -9.9 mmol/L↓, SO₂c 97%. April 8, 14:35:05 (urgent) Coagulation profile and fibrinolysis: Prothrombin time 14 s, activity 61.6%↓, APTT 28.5 s, PT INR 1.17↑, fibrinogen 3.62 g/L, thrombin time 14.6 s, D-dimer 0.94 mg/L↑, FDP 3.01 mg/L. April 8, 14:34:46 (urgent) BNP and cardiac markers: Myoglobin 214.11 ng/ml↑, BNP 390.02 pg/ml↑, CK-MB 3.34 ng/ml, hs-TnI 0.044 ng/ml↑. April 8, 14:34:37 (urgent) Liver function, renal function, electrolytes (rapid): K⁺ 3.4 mmol/L↓, Na⁺ 146 mmol/L↑, Cl⁻ 118 mmol/L↑, urea 11.3 mmol/L↑, creatinine 230 µmol/L↑, uric acid 532 µmol/L↑, ALT 21 U/L, total bilirubin 7 µmol/L, direct bilirubin 3.45 µmol/L, total protein 74 g/L, albumin 31 g/L↓, ALP 230 U/L↑, GGT 16 U/L, GFR 26.65 ml/min. April 8, 13:47:04 (urgent) CRP, CBC, SAA: WBC 6.8 × 10⁹/L, neutrophils 65.8%, lymphocytes 26.8%, RBC 3.38 × 10¹²/L↓, Hb 110 g/L↓, Hct 33.5%↓, RDW 16.1%↑, platelets 186 × 10⁹/L, CRP 7.17 mg/L, SAA 11.53 mg/L. April 8, 17:11:27 (urgent) Procalcitonin 0.07 ng/ml↑. April 12, 09:06:50 Stool examination: Normal findings, transferrin weakly positive. April 10, 10:42:44 Urinalysis: Trace occult blood, trace protein, pH 5.5, specific gravity 1.009↓. April 10, 15:17:17 Respiratory pathogen IgM panel: All negative. April 10, 08:49:49 ESR 46 mm/h↑. April 10, 14:33:09 Liver function, lipids, glucose, etc.: Albumin 29.5 g/L↓, total bile acids 14.5 µmol/L↑, magnesium 0.64 mmol/L↓, serum iron 10.31 µmol/L↓, CK-MB 5.56 ng/ml↑. April 10, 11:00:13 HbA1c 5.3%. April 10, 10:08:12 Thyroid antibodies: aTG 183 IU/ml↑, aTPO 50.6 IU/ml↑, TG 0.63 ng/ml↓. April 10, 14:13:37 Thyroid function: T3 0.97 nmol/L↓, free T3 2.14 pmol/L↓, free T4 10.4 pmol/L↓, TSH 2.581 µIU/ml. April 10, 14:19:16 Hepatitis B and C serology: Negative HBsAg, positive anti-HBe and anti-HBc. April 12, 09:25:02 Gram stain of sputum: Gram-negative cocci found. April 12, 09:24:59 Sputum culture: Normal flora. April 10, 13:51:57 AFB smear: Negative. April 10, 13:45:22 Tumor markers: CEA 6.84 ng/ml↑, SCC 6.2 ng/ml↑, CA50 37.99 U/ml↑, ProGRP 92.64 pg/ml↑. April 10, 14:48:55 (1,3)-β-D-glucan 199.88 pg/ml↑. April 10, 13:37:04 Immunoglobulins: IgG 2430 mg/dl↑, C3 46 mg/dl↓, C1q 249.1 mg/L↑. April 10, 10:55:55 Urine protein/creatinine ratio 41.2 mg/g↑. April 10, 14:55:44 HIV, syphilis, RPR: Negative. April 10, 10:18:08 sST2 34.3 ng/ml. April 10, 15:06:40 Cytokines: IL-2R 1412 U/ml↑. April 9–13 serial urgent labs showed persistent mild metabolic acidosis, elevated creatinine (199–230 µmol/L), hypokalemia, anemia, and elevated cardiac markers. April 13, 08:13:08 CBC: Hb 99 g/L↓. Special Examinations and Consultations April 13 Thyroid ultrasound: Left lobe nodule (TI-RADS 3), right lobe normal. April 13 Abdominal ultrasound: Right kidney cyst and stone, gallbladder cholesterol crystals, prostatic hyperplasia with calcification. April 13 Vascular ultrasound: Left vertebral artery occlusion, right vertebral artery increased resistance index, bilateral carotid plaques. Lower limb arteries and veins: plaques but patent flow. April 13 Echocardiogram: LVEF 67%, mild septal hypertrophy, mild mitral and aortic regurgitation, focal aortic valve calcification. April 10 ECG: Sinus bradycardia, complete right bundle branch block, left anterior fascicular block. April 10 Pulmonary function: Normal ventilation, mild diffusion impairment, increased residual volume. April 10 Nephrology consultation: Recommended low-salt, low-purine, high-quality protein diet; switch benzbromarone to febuxostat; add sodium bicarbonate and potassium citrate; monitor renal function. April 13 Vascular surgery consultation: Vertebral artery occlusion – start clopidogrel 50 mg daily. Treatment Course After admission, the patient underwent comprehensive evaluation. Treatment included rest, oxygen saturation monitoring, expectorants and mucolytics (ambroxol, acetylcysteine nebulization), bronchodilators (salbutamol, tiotropium nebulization), uric acid-lowering agents (benzbromarone, sodium bicarbonate, febuxostat), renal protection (compound α-keto acid, Shen Shuai Ning), potassium supplementation, anticoagulation (dalteparin), blood pressure control (furosemide, spironolactone), iron supplementation, and antiplatelet therapy (clopidogrel). Given the right lung lesions, infection was considered most likely, but tumor could not be excluded. Because of significant comorbidities and relative bradycardia, the family declined bronchoscopy and PET-CT after discussion of risks. They were informed of the possibility of missed diagnosis or delayed treatment and expressed understanding. After treatment, the patient’s condition improved, and he was discharged with approval from the attending physician. Comorbidities None listed. Discharge Status No fever, no cough or sputum, normal bowel and bladder function, good appetite, sound sleep. Physical examination: Alert, comfortable breathing, BP 135/80 mmHg, coarse breath sounds without rales, HR 60/min regular, no lower limb edema, SpO₂ 97% on room air. Discharge Instructions 1. Follow-up with respiratory clinic; repeat chest CT in 1 month. 2. Discharge medications: Compound α-keto acid 4 tablets three times daily with meals Shen Shuai Ning 4 capsules three times daily Sodium bicarbonate 1 tablet three times daily Febuxostat half tablet once daily Clopidogrel 50 mg (2 × 25 mg) once daily 3. Regular renal function monitoring and nephrology follow-up. 4. Await lung cancer autoantibody results (call in 1 week). 5. Monitor blood pressure and cardiology follow-up. Regular thyroid function checks and endocrinology follow-up. 6. Elevated tumor markers (CEA, SCC, CA50, ProGRP) – repeat as needed and consider PET-CT. 7. Regular carotid and vertebral artery ultrasound and vascular surgery follow-up. Treatment Outcome Improved. Rehabilitation Guidance and Health Education 1. Rest adequately, avoid catching cold during seasonal changes, keep warm, eat a balanced diet, and exercise to strengthen immunity. 2. Avoid overexertion; stay away from crowded places during flu season and treat upper respiratory infections promptly. Laboratory Report Clinical diagnosis: pulmonary shadow Department: Respiratory Medicine Ward Specimen type: blood Item Result Reference range Unit p53 autoantibody 0.1 (0.00-13.10) U/ml PGP9.5 autoantibody 0.9 (0.00-11.10) U/ml SOX2 autoantibody 0.1 (0.00-10.30) U/ml GAGE7 autoantibody 0.1 (0.00-14.40) U/ml GBU4-5 autoantibody 0.1 (0.00-7.00) U/ml MAGE autoantibody 0.1 (0.00-11.90) U/ml CAGE autoantibody 0.1 (0.00-7.20) U/ml Sampling time: April 14, 2023 04:28:00 Receipt time: April 14, 2023 08:47:54 Report time: April 21, 2023 09:50:22 Print time: April 26, 2023 12:09:08 Report writing time: May 1, 2023 17:13 Outpatient prescription Grade 2 hypertension, very high-risk group Aspirin enteric-coated tablets 100 mg once daily Atorvastatin calcium tablets 20 mg once daily Valsartan capsules 80 mg once daily Electrocardiogram report Ward: Neurology Emergency Department HR: 61 bpm P-R: 184 ms QRS: 132 ms AXIS: -64° QT/QTc: 446/450 ms RV₅/SV₁: 2.62/0.08 mV Electrocardiogram diagnosis: 1. Sinus rhythm 2. Complete right bundle branch block 3. Left anterior fascicular block 4. Left ventricular high voltage 5. q waves in V₄-V₆ Laboratory Report Department: Neurology Emergency Department Specimen type: EDTA anticoagulated blood Item: White blood cell count Result: 8.6 Reference range: (3.5-9.5 × 10⁹/L) Item: Neutrophil % Result: 84.9↑ Reference range: (40-75 %) Item: Lymphocyte % Result: 9.7↓ Reference range: (20-50 %) Item: Monocyte % Result: 3.8 Reference range: (3-10 %) Item: Eosinophil % Result: 1.3 Reference range: (0.4-8 %) Item: Basophil % Result: 0.3 Reference range: (0.0-1.0 %) Item: Red blood cell count Result: 3.32↓ Reference range: (4.3-5.8 × 10¹²/L) Item: Hemoglobin Result: 107↓ Reference range: (130-175 g/L) Item: Hematocrit Result: 33.9↓ Reference range: (40-50 %) Item: Mean corpuscular volume Result: 102.1↑ Reference range: (82-100 fL) Item: Mean corpuscular hemoglobin Result: 32.2 Reference range: (27-34 pg) Item: Mean corpuscular hemoglobin concentration Result: 316 Reference range: (316-354 g/L) Item: Red cell distribution width Result: 14.4 Reference range: (11.0-16.0 %) Item: Platelet count Result: 170 Reference range: (125-350 × 10⁹/L) Item: Mean platelet volume Result: 9.6 Reference range: (6.5-13 fL) Item: Platelet distribution width Result: 9.6 Reference range: (9-18.1 %) Item: C-reactive protein Result: 13.41↑ Reference range: (< 8 mg/L) Item: SAA Result: 19.51↑ Reference range: (0.00-10.00 mg/L) Sampling time: May 1, 2023 18:04:08 Medical record: May 1, 2023 18:08:23 Emergency department Emergency head CT showed Softening focus in the left basal ganglia, enlarged ventricles Brain atrophy, no obvious hemorrhagic foci Neurology emergency consultation requested Radiology report Department: Internal Medicine Emergency Department Examination: Non-contrast chest CT Radiological findings: Bilateral thoracic symmetry, normal lucency. Increased lung markings bilaterally. Scattered patchy hazy opacities in the right lung and left lower lobe, with partial consolidation in the right lower lobe. Fibrous streaky opacities and traction bronchiectasis in the right middle and lower lobes. Trachea and mediastinum central. Heart shadow normal. Scattered calcifications in the aortic wall, aortic valve, and coronary artery walls. Small right pleural effusion. Thickened wall in the lower esophagus. Diagnosis: Scattered infection in the right lung and left lower lobe, partial consolidation in the right lower lobe, small right pleural effusion—follow-up after treatment. Fibrous streaky opacities and traction bronchiectasis in the right middle and lower lobes. Scattered calcifications in the aortic wall, aortic valve, and coronary artery walls. Thickened wall in the lower esophagus. Report writing time: July 20, 2023 19:34 Report review time: July 20, 2023 19:58 Radiology report Department: Internal Medicine Emergency Department /Requesting physician: to assist with clinical diagnosis Examination: Non-contrast upper abdominal CT Radiological findings: Liver normal in size, no obvious abnormalities in parenchymal density. No obvious dilatation of intrahepatic bile ducts. Enlarged gallbladder. Common bile duct mildly dilated, with linear dense shadows in the bile duct wall. Atrophic pancreas, no obvious dilatation of the pancreatic duct. Spleen normal. Left kidney small, right kidney compensatory hypertrophy. Small roundish low-density and slightly high-density lesions in the right kidney, the largest about 6 mm. Punctate dense shadow in the right renal pelvis, about 2 mm. Dilatation and hydronephrosis of the right renal pelvis and upper ureter, with a nodular dense shadow about 7 mm in diameter in the upper right ureter. Obvious dilatation and hydronephrosis of the right renal pelvis and upper ureter. No obvious enlarged lymph nodes at the hepatic hilum or retroperitoneum. Thickened gastric antrum wall. Bilateral adrenal glands normal. Increased density in surrounding fat planes and greater omentum, with flocculent hazy shadows. Fecal impaction in the colon. Radiological diagnosis: Small left kidney, compensatory hypertrophy of the right kidney. Stone in the upper right ureter with dilatation and hydronephrosis of the right kidney and upper ureter. Stones and small cystic lesions in the right kidney. Enlarged gallbladder, mildly dilated common bile duct with dense shadows in the bile duct wall—possible calcification? Suggest MRCP for further evaluation. Thickened gastric antrum wall. Hazy exudative shadows in mesenteric fat planes and greater omentum—correlate clinically. Fecal impaction in the colon. Report writing time: July 20, 2023 19:34 Report review time: July 20, 2023 20:06 Discharge Summary Department: Nephrology Ward Visit Date: July 21, 2023 Admission Date: July 21, 2023 07:02:44 Discharge Date: August 7, 2023 Outpatient/Emergency Diagnosis 1. Acute renal failure; AKI stage 3; 2. Chronic kidney disease stage 4; renal anemia; CKD-MBD; 3. Grade 1 hypertension; 4. Hyperuricemia; 5. Vertebral artery occlusion; 6. Sinus bradycardia; 7. Hydronephrosis with renal and ureteral stones; Admission Diagnosis 1. Acute renal failure; AKI stage 3; 2. Chronic renal insufficiency; CKD stage 4; renal anemia; CKD-MBD; 3. Grade 1 hypertension; 4. Hyperuricemia; 5. Vertebral artery occlusion; 6. Sinus bradycardia; 7. Renal pelvic dilatation; 8. Hydronephrosis with renal and ureteral stones; Discharge Diagnosis 1. Acute renal failure; 2. Chronic renal insufficiency; 3. Grade 1 hypertension; 4. Hyperuricemia; 5. Vertebral artery occlusion; 6. Sinus bradycardia; 7. Renal pelvic dilatation; 8. Hydronephrosis with renal and ureteral stones; 9. Benign prostatic hyperplasia; 10. Cardiac insufficiency; Main Symptoms and Signs on Admission 1. Elderly male patient, 75 years old, 2. Admitted for “elevated serum creatinine discovered 20 years ago, with recent worsening accompanied by poor appetite and fatigue for 1 day.” 3. Physical examination: Alert, normal breathing, BP 139/73 mmHg, coarse breath sounds in both lungs without dry or wet rales, HR 51 beats/min. Soft abdomen, no tenderness or rebound tenderness, negative renal region percussion tenderness, bilateral lower extremity pitting edema (+), fingertip oxygen saturation 97%. 4. Auxiliary examinations: See brief medical history. Main Laboratory Results July 21, 12:31:27 (urgent) Procalcitonin 0.27 ng/ml ↑ July 21, 11:46:07 (urgent) Complete blood count White blood cell count: 2.4 × 10⁹ /L ↓, Neutrophil %: 46.2%, Lymphocyte %: 39.8%, Monocyte %: 10.9% ↑, Eosinophil %: 2.2%, Basophil %: 0.9%, Red blood cell count: 2.58 × 10¹² /L ↓, Hemoglobin: 82 g/L ↓, Hematocrit: 25.1% ↓, Mean corpuscular volume: 97.3 fl, Mean corpuscular hemoglobin: 31.8 pg, Mean corpuscular hemoglobin concentration: 327 g/L, Red cell distribution width: 14.4%, Platelet count: 112 × 10⁹ /L ↓, Mean platelet volume: 8.7 fl, Platelet distribution width: 17.6%, C-reactive protein: 27.17 mg/L ↑, July 21, 12:39:52 (urgent) Coagulation profile and (urgent) Fibrinolysis parameters (FDP+DD) Prothrombin time: 14.7 seconds ↑, Activity: 64.7% ↓, Activated partial thromboplastin time: 33.9 seconds, PT INR: 1.25 ↑, Fibrinogen: 3.14 g/L, Thrombin time: 15.5 seconds, D-dimer: 2.08 mg/L ↑, July 21, 12:23:13 (urgent) B-type natriuretic peptide: 381.68 pg/ml ↑, July 21, 12:25:10 (urgent) Myocardial infarction markers (rapid) Myoglobin: 5.39 ng/ml ↑, High-sensitivity troponin I: 0.015 ng/ml, July 21, 12:25:48 (urgent) Renal function (rapid) and (urgent) Electrolytes Potassium: 5.6 mmol/L ↑, Sodium: 141 mmol/L, Chloride: 104 mmol/L, Urea nitrogen: 41.3 mmol/L ↑, Creatinine: 957 umol/L ↑, Uric acid: 677 umol/L ↑, Calcium: 1.4 mmol/L ↓, Phosphorus: 3.01 mmol/L ↑, Magnesium: 0.7 mmol/L, GFR: 5.43 ml/min, July 21, 11:52:58 (urgent) (Carboxy) Blood gas analysis pH: 7.24 ↓, pCO₂: 4.5 kPa ↓, pO₂: 14.6 kPa ↑, Cl⁻: 106 mmol/L, Ca⁺⁺: 0.8 mmol/L ↓, Hct: 22% ↓, Glu: 5.2 mmol/L, Lac: 1.3 mmol/L, tHb: 85 g/L ↓, O₂Hb: 97.1% ↑, COHb: 0.7%, MetHb: 2.1%, HHb: 2.1%, tCO₂: 15.6 mmol/L ↓, BE(B): -11.8 mmol/L ↓, AG: 17 mmol/L, HCO₃⁻: 14.6 mmol/L ↓, Na⁺: 132 mmol/L ↓, July 24, 15:08:14 Pre-transfusion screening Hepatitis B virus surface antigen: 0.00 (-) IU/ml, Anti-hepatitis B virus surface antibody: 1.24 (-) mIU/mL, Hepatitis B virus e antigen: 0.38 (-), Anti-hepatitis B virus e antibody: 0.01 (+), Anti-hepatitis B virus core antibody: 0.01 (+), Hepatitis C virus core antigen: Negative (-), Anti-Treponema pallidum antibody: Negative (-), Anti-human immunodeficiency virus antibody: Negative (-), Alanine aminotransferase: 8 U/L, July 22, 14:24:41 Liver function 1, Liver function 2, Renal function, Blood lipids, Electrolytes, Cardiac enzymes, Glucose metabolism Total bilirubin: 5 umol/L, Direct bilirubin: 2.7 umol/L, Total protein: 65.9 g/L, Albumin: 25.5 g/L ↓, Alanine aminotransferase: 7.8 U/L ↓, Aspartate aminotransferase: 17.2 U/L, Alkaline phosphatase: 113.9 U/L, γ-Glutamyl transpeptidase: 10.4 U/L, Aspartate aminotransferase mitochondrial isoenzyme: 1.4 U/L, Total bile acid: 2.2 umol/L, Cholinesterase: 4102.4 U/L, Urea: 32.22 mmol/L ↑, Creatinine: 729.4 umol/L ↑, Uric acid: 532.9 umol/L ↑, Retinol-binding protein: 26.9 mg/L, Cystatin C: 3.18 mg/L ↑, Total cholesterol: 2.77 mmol/L, Triglycerides: 1.12 mmol/L, High-density lipoprotein cholesterol: 0.65 mmol/L, Low-density lipoprotein cholesterol: 1.94 mmol/L, Serum apolipoprotein A-I: 0.76 g/L ↓, Serum apolipoprotein B: 0.6 g/L, Serum lipoprotein(a): 125.7 mg/L, Serum apolipoprotein E: 23.38 mg/L ↓, Free fatty acids: 0.708 mmol/L, Small dense low-density lipoprotein cholesterol: 0.432 mmol/L, Serum potassium: 4.84 mmol/L ↓, Serum sodium: 135.7 mmol/L ↓, Chloride: 103 mmol/L, Carbon dioxide combining power: 15.3 mmol/L ↓, Glucose: 2.72 mmol/L ↓, Glutathione reductase: 63.5 u/L, Adenosine deaminase: 20.1 U/L ↑, α-L-Fucosidase: 17.8 U/L, Prealbumin: 83.9 mg/L ↓, Haptoglobin: 0.76 g/L, α-1 Acid glycoprotein: 1.1 g/L, Creatine kinase: 156.6 U/L, Creatine kinase isoenzyme: 3.53 ng/mL, Lactate dehydrogenase: 244.1 U/L, α-Hydroxybutyrate dehydrogenase: 187.2 U/L ↑, Glycated albumin: 23.5% ↑, GFR: 7.36 ml/min, July 22, 12:45:54 Glycated hemoglobin (high-pressure liquid chromatography) High-pressure liquid chromatography (glycated hemoglobin): 5.4%, July 24, 09:38:47 Other (Procalcitonin PTH\EPO\IgE\HCY) HCY: 26.64 μmol/L ↑, July 25, 09:11:36 Other (Procalcitonin PTH\EPO\IgE\HCY) PTH: 47.9 pmol/L ↑, EPO: 10.7 mIU/ml, Procalcitonin: <2.00, Total IgE: 1741 IU/ml ↑, July 24, 15:52:22 25-HVD 25-Hydroxyvitamin D: <20.0 ng/ml, July 24, 13:38:01 VB12II/Folate, Thyroid Folate: >54.83 nmol/L, Vitamin B12: 558.72 pmol/L, July 24, 13:40:27 VB12II/Folate, Thyroid aTG: 225 IU/ml ↑, aTPO: 81.4 IU/ml ↑, TG: 2.25 ng/ml, Thyroid-stimulating hormone receptor antibody: 0.82 IU/L, July 24, 15:30:55 VB12II/Folate, Thyroid T3: 0.62 nmol/L ↓, T4: 46.5 nmol/L ↓, Free T3: 0.62 pmol/L ↓, Free T4: 6.65 pmol/L ↓, Thyroglobulin: 16.6 μg/ml, Thyroid-stimulating hormone stimulating antibody: <0.10 IU/L, July 22, 14:23:13 Iron metabolism Serum iron: 19.75 umol/L, Total iron-binding capacity: 30.2 umol/L ↓, Soluble transferrin receptor: 21.03 nmol/L, July 22, 08:27:16 Ret Reticulocyte count: 1.1%, Absolute reticulocyte count: 29.5, July 26, 13:57:04 Autoantibodies 1, Autoantibodies 2, Autoantibodies 3 Antinuclear antibody IgG: Negative (-), Antinuclear antibody spectrum IgG: ..., --Anti-U1-nRNP: 16, --Anti-Sm antibody: 32, --Anti-SSA-52 antibody: 23, --Anti-SSA-60 antibody: 8, --Anti-SS-B antibody: 8, --Anti-Jo-1 antibody: 11, --Anti-Scl-70: 56, --ds-DNA: 85, --AMA-M2: 236 ↑, --PM-Scl: 27, --PCNA: 17, --Anti-centromere antibody: 30, --Anti-nucleosome antibody: 25, --Anti-histone antibody: 26, --Anti-ribosomal P protein: 17, CANCA: Negative (-), PR3-ANCA: 31, PANCA: Negative (-), MPO-ANCA: 13, Anti-GBM antibody: 2, Anti-smooth muscle antibody: Negative (-), Anti-mitochondrial antibody: Negative (-), July 24, 14:54:00 Specific proteins + Rheumatism panel Complement titer: 41.4 U/mL, Anti-cyclic citrullinated peptide CCP: 26.16 U/mL, July 27, 15:58:36 Anticardiolipin antibody + Anti-β2 glycoprotein I antibody Anticardiolipin antibody IgA (send-out): 3.21 RU/ml, Anticardiolipin antibody IgM (send-out): 7.42 RU/ml, Anticardiolipin antibody IgG (send-out): 7.77 RU/ml, Anti-β2 glycoprotein I antibody IgA (send-out): 6.25 RU/ml, Anti-β2 glycoprotein I antibody IgM (send-out): 9.71 RU/ml, Anti-β2 glycoprotein I antibody IgG (send-out): 2.59 RU/ml, July 24, 16:58:35 Immunofixation electrophoresis Serum immunofixation electrophoresis IgG: Negative (-), Serum immunofixation electrophoresis IgA: Negative (-), Serum immunofixation electrophoresis IgM: Negative (-), Serum immunofixation electrophoresis κ: Negative (-), Serum immunofixation electrophoresis λ: Negative (-), Urine immunofixation electrophoresis IgG: Negative (-), Urine immunofixation electrophoresis IgA: Negative (-), Urine immunofixation electrophoresis IgM: Negative (-), Urine immunofixation electrophoresis κ: Negative (-), Urine immunofixation electrophoresis λ: Negative (-), July 24, 15:03:57 Serum κ, λ light chain assay κ-light chain: 8.93 g/L ↑, λ-light chain: 3.46 g/L ↑, κ/λ: 2.58, July 24, 09:44:16 Tumor markers, Prostate tumor CA72-4: 1.21 U/ml, NSE: 11.68 ng/ml, July 24, 11:43:39 Tumor markers, Prostate tumor Ferritin: 198.56, SCC: 4.5 ng/ml ↑, AFP: 1.56 ng/ml, CA15-3: 11.7 U/ml, CA21-1: 1.64 ng/ml, CA19-9: 11.06 ng/ml, July 24, 13:33:26 Tumor markers, Prostate tumor CA50: 57.71 U/ml ↑, CA-242: 23.21 U/ml, July 24, 15:23:40 Tumor markers, Prostate tumor PSA: 0.17 ng/ml, Free PSA: 0.11 ng/ml, F/T-PSA: 0.65, β2-MG: 11978 ng/ml ↑, Prostatic acid phosphatase: 0.42 ng/ml, July 22, 09:26:48 Urine ACR + Urinalysis + Urine sediment, Urine nuclear matrix protein Color: Light yellow, Clarity: Clear, Leukocyte esterase: Negative, Urobilinogen: Negative, Occult blood: Negative, Bilirubin: Negative, Ketone bodies: Negative, Glucose: Negative, Urine creatinine: 10, Microalbumin: 1+, Protein: Negative, pH: 7, Nitrite: Negative, Specific gravity: 1.011 ↓, Leukocytes (sediment): 0.1 /uL, Leukocyte clumps: Negative, Erythrocytes (sediment): 17.3 /uL, Epithelial cells: 0.4 /ul, Casts: 0 /ul, Hyaline, Epithelial cells: 0.5 /ul, Non-squamous epithelial cells: Negative, Mucus: Negative, Crystals: Negative, Fungi: Negative, Albumin/creatinine ratio: >30, Dysmorphic erythrocytes: Negative, Urine nuclear matrix protein: Negative, July 24, 15:31:10 24-hour urine protein quantification Urine volume: 1.1 L, 24h urine protein: 242.13 mg/day ↑, July 22, 12:28:08 Urine albumin/creatinine ratio, Urine series proteins Urine albumin/creatinine ratio: 117.93 mg/g ↑, Urine IgG: 43.29 mg/L ↑, Urine transferrin: 1.74 mg/L, Urine microalbumin: 25.28 mg/L, β₂-microglobulin: 23.72 mg/L ↑, Urine N-acetyl-β-D-glucosaminidase: 3.57 U/L, α₁-microglobulin: 42.4 mg/L ↑, Urine creatinine: 1895 umol/L, July 22, 09:23:43 Urine Bence-Jones protein qualitative test Bence-Jones protein: Negative, July 24, 15:31:22 24-hour urine potassium, sodium, chloride Urine volume: 1.1 L, 24-hour urine chloride: 78 mmol/24h ↓, 24-hour urine potassium: 4 mmol/24h ↓, 24-hour urine sodium: 100 mmol/24h, July 24, 09:03:38 Comprehensive stool examination Color: Brown, Consistency: Soft stool, Mucus: Negative, Blood: Negative, Leukocytes: 0, Erythrocytes: 0, Ascaris eggs: Not seen, Hookworm eggs: Not seen, Whipworm eggs: Not seen, Schistosome eggs: Not seen, Fungi: Negative, Helicobacter pylori antigen: Negative, Adenovirus: Negative, Rotavirus antigen: Negative, Transferrin: Negative, Amoeba: Not seen, Occult blood test (antibody method): Negative, July 22, 11:44:10 Thromboelastography-CK (no heparin) R (coagulation factor activity, lower value偏高): 4.6 min, K (fibrinogen function, lower value偏高): 1.1 min, Angle (fibrinogen function, higher value偏高): 73.5 deg ↑, LY30 (fibrinolysis index, >8 indicates hyperfibrinolysis): 0%, MA (platelet function, higher value偏高): 63.7 mm, EPL (fibrinolysis index, >15 indicates hyperfibrinolysis): 0%, Comprehensive coagulation index: 2.2, July 24, 15:19:12 Other vitamins VA: 0.74 umol/L, VB₁: 108.94 nmol/L, VB₂: 10.31 nmol/L, 5:70.26 nmol/L, VB₉: 12.55 nmol/L, VC: 50.65 umol/L, VE: 9.09 umol/L, July 22, 13:13:02 (test) 11 Cytokines IL-1β: 1.25 pg/mL, IL-2R: 1875 U/mL ↑, IL-2: 15 pg/mL, IL-4: 1.08 pg/mL, IL-5: 1.33 pg/mL, IL-6: 6.54 pg/mL, IL-8: 48.51 pg/mL, IL-10: 41 pg/mL, IL-17A: 1.59 pg/mL, TNF-α: 3.45 pg/mL, IFN-γ: 0.43 IU/mL, July 22, 06:40:25 (urgent) (Carboxy) Blood gas analysis pH: 7.31 ↓, pCO₂: 4.8 kPa, pO₂: 19.2 kPa ↑, Cl⁻: 105 mmol/L, Ca⁺⁺: 0.87 mmol/L ↓, Hct: 25% ↓, Glu: 3.2 mmol/L ↓, Lac: 1.1 mmol/L, tHb: 90 g/L ↓, O₂Hb: 97.2% ↑, COHb: 0.2%, MetHb: 0%, HHb: 2.6%, SO₂: 97.4%, tCO₂: 19.2 mmol/L ↓, BE(B): -7.5 mmol/L ↓, AG: 16 mmol/L, HCO₃⁻: 18.1 mmol/L, Na⁺: 134 mmol/L ↓, July 25, 07:47:17 (urgent) Liver function (rapid), (urgent) Renal function (rapid), (urgent) Electrolytes (rapid), (urgent) Rapid blood glucose, (urgent) Trace elements Potassium: 3.3 mmol/L ↓, Sodium: 139 mmol/L, Chloride: 101 mmol/L, Urea nitrogen: 12.5 mmol/L ↑, Creatinine: 454 umol/L ↑, Uric acid: 225 umol/L, Glucose: 4.4 mmol/L, Alanine aminotransferase: 12 U/L, Total bilirubin: 6 umol/L, Direct bilirubin: 5.5 umol/L, Total protein: 65 g/L, Albumin: 24 g/L ↓, Alkaline phosphatase: 97 U/L, γ-Glutamyl transpeptidase: 12 U/L ↓, Calcium: 1.66 mmol/L ↓, Phosphorus: 1.4 mmol/L, Magnesium: 0.63 mmol/L ↓, GFR: 12.48 ml/min, July 25, 07:57:17 (urgent) CRP, (urgent) Complete blood count White blood cell count: 5.7 × 10⁹ /L, Neutrophil %: 63.9%, Lymphocyte %: 23.6%, Monocyte %: 10.5% ↑, Eosinophil %: 1.7%, Basophil %: 0.3%, Red blood cell count: 2.54 × 10¹² /L ↓, Hemoglobin: 80 g/L ↓, Hematocrit: 24.5% ↓, Mean corpuscular volume: 96.5 fl, Mean corpuscular hemoglobin: 31.5 pg, Mean corpuscular hemoglobin concentration: 327 g/L, Red cell distribution width: 12.8%, Platelet count: 47 × 10⁹ /L ↓, Platelet distribution width: 12.2%, Mean platelet volume: 12.1 fl, C-reactive protein: 10.16 mg/L ↑, July 25, 08:01:34 (urgent) Myocardial infarction markers (rapid) Myoglobin: 193.01 ng/ml ↑, Creatine kinase isoenzyme: 1.69 ng/ml, High-sensitivity troponin I: 0.03 ng/ml, July 25, 07:22:25 (urgent) B-type natriuretic peptide: 584.98 pg/ml ↑, July 25, 07:35:26 (urgent) Coagulation profile, (urgent) Fibrinolysis parameters (FDP+DD) Prothrombin time: 17.4 seconds ↑, Activity: 49.3% ↓, Activated partial thromboplastin time: 36.8 seconds, PT INR: 1.5 ↑, Fibrinogen: 2.21 g/L, Thrombin time: 19.7 seconds, D-dimer: 4.1 mg/L ↑, Fibrin degradation products: 11.67 mg/L ↑, July 26, 07:35:05 (urgent) CRP, (urgent) Complete blood count White blood cell count: 6.1 × 10⁹ /L, Neutrophil %: 65.2%, Lymphocyte %: 24.1%, Monocyte %: 8.9%, Eosinophil %: 1.3%, Basophil %: 0.5%, Red blood cell count: 2.37 × 10¹² /L ↓, Hemoglobin: 77 g/L ↓, Hematocrit: 22.6% ↓, Mean corpuscular volume: 95.4 fl, Mean corpuscular hemoglobin: 32.5 pg, Mean corpuscular hemoglobin concentration: 341 g/L, Red cell distribution width: 12.8%, Platelet count: 53 × 10⁹ /L ↓, Platelet distribution width: 11.7%, Mean platelet volume: 11.6 fl, C-reactive protein: 6.15 mg/L, July 26, 08:04:39 (urgent) Renal function (rapid), (urgent) Electrolytes (rapid) Potassium: 4.4 mmol/L, Sodium: 137 mmol/L, Chloride: 104 mmol/L, Urea nitrogen: 14.3 mmol/L ↑, Creatinine: 531 umol/L ↑, Uric acid: 251 umol/L, GFR: 10.48 ml/min, August 1, 14:09:37 Anti-platelet specific antibodies Anti-platelet membrane glycoprotein IX specific antibody: Negative, Anti-platelet membrane glycoprotein Ib specific antibody: Negative, Anti-platelet membrane glycoprotein IIb specific antibody: Negative, Anti-platelet membrane glycoprotein IIIa specific antibody: Negative, Anti-platelet α-granule membrane protein (GMP140) specific antibody: Positive, July 27, 07:42:19 (urgent) CRP, (urgent) Complete blood count White blood cell count: 7.3 × 10⁹ /L, Neutrophil %: 63.7%, Lymphocyte %: 26.2%, Monocyte %: 8.1%, Eosinophil %: 1.6%, Basophil %: 0.4%, Red blood cell count: 2.59 × 10¹² /L ↓, Hemoglobin: 81 g/L ↓, Hematocrit: 24.7% ↓, Mean corpuscular volume: 95.4 fl, Mean corpuscular hemoglobin: 31.3 pg, Mean corpuscular hemoglobin concentration: 328 g/L, Red cell distribution width: 12.6%, Platelet count: 71 × 10⁹ /L ↓, Platelet distribution width: 13.2%, Mean platelet volume: 11.6 fl, C-reactive protein: 5.05 mg/L, July 27, 07:43:58 (urgent) Renal function (rapid), (urgent) Electrolytes (rapid) Potassium: 4.1 mmol/L, Sodium: 135 mmol/L ↓, Chloride: 103 mmol/L, Urea nitrogen: 16.1 mmol/L ↑, Creatinine: 557 umol/L ↑, Uric acid: 265 umol/L, GFR: 9.94 ml/min, July 29, 11:39:14 General bacterial culture and identification No bacterial growth after 2 days of culture July 29, 08:12:24 (urgent) Liver function (rapid), (urgent) Renal function (rapid), (urgent) Electrolytes (rapid), (urgent) Trace elements Potassium: 3.7 mmol/L, Sodium: 136 mmol/L ↓, Chloride: 104 mmol/L, Urea nitrogen: 16.3 mmol/L ↑, Creatinine: 443 umol/L ↑, Uric acid: 284 umol/L, Alanine aminotransferase: 9 U/L, Total bilirubin: 4 umol/L, Direct bilirubin: 4.2 umol/L, Total protein: 67 g/L, Albumin: 27 g/L ↓, Alkaline phosphatase: 86 U/L, γ-Glutamyl transpeptidase: 14 U/L ↓, Calcium: 1.9 mmol/L ↓, Phosphorus: 1.58 mmol/L ↑, Magnesium: 0.65 mmol/L ↓, GFR: 12.83 ml/min, July 29, 07:18:43 (urgent) CRP, (urgent) Complete blood count White blood cell count: 7.7 × 10⁹ /L, Neutrophil %: 69.3%, Lymphocyte %: 24%, Monocyte %: 5.9%, Eosinophil %: 0.5%, Basophil: 0.4%, Red blood cell count: 2.73 × 10¹² /L ↓, Hemoglobin: 91 g/L ↓, Hematocrit: 26.7% ↓, Mean corpuscular volume: 97.8 fl, Mean corpuscular hemoglobin: 33.2 pg, Mean corpuscular hemoglobin concentration: 339 g/L, Red cell distribution width: 14.1%, Platelet count: 74 × 10⁹ /L ↓, Mean platelet volume: 9.9 fl, Platelet distribution width: 19.1% ↑, C-reactive protein: 2.95 mg/L, July 29, 08:17:43 (urgent) Coagulation profile, (urgent) Fibrinolysis parameters (FDP+DD) Prothrombin time: 26.3 seconds ↑, Activity: 27.5% ↓, Activated partial thromboplastin time: 40.9 seconds ↑, PT INR: 2.35 ↑, Fibrinogen: 2.12 g/L, Thrombin time: 17 seconds, D-dimer: 3.52 mg/L ↑, July 29, 07:38:08 (urgent) B-type natriuretic peptide: 1025.91 pg/ml ↑, July 29, 08:17:30 (urgent) Myocardial infarction markers (rapid) Myoglobin: 105.7 ng/ml, Creatine kinase isoenzyme: 1.27 ng/ml, High-sensitivity troponin I: 0.018 ng/ml, July 31, 08:50:36 (urgent) Liver function (rapid), (urgent) Renal function (rapid), (urgent) Electrolytes (rapid), (urgent) Trace elements Potassium: 3.6 mmol/L, Sodium: 138 mmol/L, Chloride: 106 mmol/L, Urea nitrogen: 17.5 mmol/L ↑, Creatinine: 381 umol/L ↑, Uric acid: 307 umol/L, Alanine aminotransferase: 9 U/L, Total bilirubin: 5 umol/L, Direct bilirubin: 5 umol/L, Total protein: 61 g/L, Albumin: 24 g/L ↓, Alkaline phosphatase: 73 U/L, γ-Glutamyl transpeptidase: 14 U/L ↓, Calcium: 1.76 mmol/L ↓, Phosphorus: 1.34 mmol/L, Magnesium: 0.65 mmol/L ↓, GFR: 15.18 ml/min, July 31, 09:39:37 (urgent) Coagulation profile, (urgent) Fibrinolysis parameters (FDP+DD) Prothrombin time: 27.1 seconds ↑, Activity: 26.4% ↓, Activated partial thromboplastin time: 40.4 seconds ↑, PT INR: 2.43 ↑, Fibrinogen: 1.92 g/L, Thrombin time: 16.5 seconds, D-dimer: 4.21 mg/L ↑, July 31, 07:47:14 (urgent) B-type natriuretic peptide: 858.09 pg/ml ↑, August 2, 08:15:20 (urgent) Liver function (rapid), (urgent) Renal function (rapid), (urgent) Electrolytes (rapid), (urgent) Trace elements Potassium: 3.8 mmol/L, Sodium: 136 mmol/L ↓, Chloride: 103 mmol/L, Urea nitrogen: 17 mmol/L ↑, Creatinine: 379 umol/L ↑, Uric acid: 354 umol/L, Alanine aminotransferase: 7 U/L, Total bilirubin: 6 umol/L, Direct bilirubin: 4.7 umol/L, Total protein: 63 g/L, Albumin: 26 g/L ↓, Alkaline phosphatase: 83 U/L, γ-Glutamyl transpeptidase: 13 U/L ↓, Calcium: 1.8 mmol/L ↓, Phosphorus: 1.53 mmol/L ↑, Magnesium: 0.67 mmol/L ↓, GFR: 15.27 ml/min, August 2, 09:06:06 (urgent) Coagulation profile, (urgent) Fibrinolysis parameters (FDP+DD) Prothrombin time: 30.6 seconds ↑, Activity: 22.4% ↓, Activated partial thromboplastin time: 42.4 seconds ↑, PT INR: 2.77 ↑, Fibrinogen: 2.47 g/L, Thrombin time: 16.1 seconds, D-dimer: 2.08 mg/L ↑, August 2, 08:28:55 (urgent) B-type natriuretic peptide: 811.78 pg/ml ↑, August 3, 08:28:37 (urgent) CRP, (urgent) Complete blood count White blood cell count: 8.5 × 10⁹ /L, Neutrophil %: 71.7%, Lymphocyte %: 19.6%, Monocyte %: 7.1%, Eosinophil %: 1.2%, Basophil %: 0.4%, Red blood cell count: 2.63 × 10¹² /L ↓, Hemoglobin: 85 g/L ↓, Hematocrit: 25.5% ↓, Mean corpuscular volume: 97 fl, Mean corpuscular hemoglobin: 32.3 pg, Mean corpuscular hemoglobin concentration: 333 g/L, Red cell distribution width: 13.7%, Mean platelet volume: 11.8 fl, C-reactive protein: 8.27 mg/L ↑, August 3, 08:55:12 (urgent) Procalcitonin: 0.23 ng/ml ↑, Special Examinations and Important Consultations 【Color Doppler Ultrasound Color Doppler Ultrasound July 21, 13:10:37】 Imaging diagnosis: Lower extremity veins: Patent deep veins in both lower extremities Lower extremity arteries: Plaque formation in bilateral lower extremity arteries with patent flow 【Color Doppler Ultrasound Color Doppler Ultrasound July 21, 13:12:22】 Imaging diagnosis: Liver: No obvious abnormality Gallbladder: Cholesterol crystals in gallbladder Pancreas: No obvious abnormality Spleen: No obvious abnormality Kidneys: Right kidney chronic kidney disease appearance, mild right hydronephrosis, right kidney stone, right kidney cyst, left kidney not visualized Ureters: Right ureteral stone with dilatation, left ureter no obvious abnormality Prostate: Benign prostatic hyperplasia with calcification 【Color Doppler Ultrasound Color Doppler Ultrasound July 21, 13:09:37】 Imaging diagnosis: Bilateral adrenal regions no obvious abnormality 【Color Doppler Ultrasound Color Doppler Ultrasound July 21, 13:11:03】 Imaging diagnosis: Bilateral renal arteries: Increased resistance index in right renal artery 【Interventional Ultrasound Interventional Ultrasound July 27, 10:03:51】 【Echocardiography Echocardiography July 21, 13:24:04】 Imaging diagnosis: Cardiac ultrasound: Slight thickening of basal segment of interventricular septum, mild mitral regurgitation, mild aortic regurgitation July 28 Contrast-enhanced abdominal CT: Left kidney atrophy, compensatory hypertrophy of right kidney. Right renal pelvic dilatation and hydronephrosis. Small right kidney stones, complex right kidney cyst, small amount of gas in right renal pelvis, right kidney drainage tube in place. Mild dilatation of intrahepatic bile ducts and upper common bile duct, bile duct wall shadows, calcification? Please correlate with MRCP. Slight thickening of gastric antrum wall. Mesenteric fat and greater omentum with hazy exudative shadows, ascites, large amount of fecal impaction in bowel. Additional findings: Small bilateral pleural effusions. Small pericardial effusion. Chronic cystitis with bladder wall thickening. Small bowel fluid retention, local rectal wall thickening, colonic fecal impaction. Pelvic fluid. Subcutaneous edema of abdominal and pelvic walls, hazy exudative shadows in pelvic fat spaces, please correlate with clinical findings. July 25 Hematology consultation: Suggest monitoring platelet changes, consider heparin-induced thrombocytopenia, active anti-infection treatment. August 1 Urology consultation: Suggest continued renal pelvic drainage, monitor renal function changes, consider surgical treatment if necessary. After admission, the patient was given rest and dietary control; kidney protection, laxatives, blood pressure control with amlodipine; urine alkalinization with sodium bicarbonate tablets; α-keto acid supplementation with compound α-keto acid tablets; hemoglobin supplementation with roxadustat; uric acid lowering with febuxostat and other symptomatic treatments. On the background of chronic kidney disease with acute exacerbation, a right internal jugular vein temporary catheter was placed on July 21 for hemodialysis. On July 27, percutaneous renal pelvic puncture and drainage were performed. The temporary catheter was removed on August 2. The patient was advised to follow up with urology at a higher-level hospital after discharge. The patient’s condition was stable, so discharge was appropriate. Complications None Discharge Status The patient’s bilateral lower extremity edema, fatigue, and difficulty with defecation had improved. Physical examination: Alert, normal breathing, BP: 166/86 mmHg, coarse breath sounds in both lungs without dry or wet rales, HR 57 beats/min, soft abdomen, no tenderness or rebound tenderness, negative renal region percussion tenderness, no bilateral lower extremity pitting edema. Management: Advise follow-up with urology at a higher-level hospital. After discussion with superiors, discharge approved. Discharge Orders 1. Outpatient follow-up, take medications as prescribed, regularly recheck liver and kidney function, electrolytes, complete blood count, 24-hour urine protein, coagulation function, BNP, urinary system ultrasound, etc. Monitor blood pressure and blood glucose changes and adjust regimen accordingly. Seek medical attention promptly if any discomfort occurs. 2. Discharge medications: Lansoprazole 15 mg × 1 box Once daily, 2 capsules each time, taken before meals Lactulose 200 ml × 1 box Once daily, 20 ml each time Benidipine tablets 8 mg × 1 box Once daily, half tablet each time Itopride 50 mg × 2 boxes Three times daily, 1 tablet each time Compound α-keto acid tablets × 1 box Three times daily, 3 tablets each time 3. The patient has obstructive nephropathy and is currently undergoing renal pelvic puncture drainage. Further evaluation at an outside hospital is recommended. Treatment Outcome Improved Rehabilitation Guidance and Health Education Prescription Rest adequately, avoid fatigue, follow a low-salt diet, and avoid nephrotoxic medications. Time: August 6, 14:15 Outpatient Visit Record Visit Date: August 7, 2023, 10:20 Department: Urology Right hydronephrosis, right ureteral stone, left kidney atrophy, renal insufficiency, status post right renal pelvis nephrostomy, serum creatinine greater than 200 umol/L. Outside hospital CT showed left kidney atrophy, right hydronephrosis, right kidney small stones, and right upper ureteral stone. The patient’s condition is currently stable with good symptom control. Physical Examination: Alert and oriented, normal mental status, soft abdomen, no tenderness or rebound tenderness, no muscle guarding. No percussion tenderness over bilateral kidney areas, no percussion tenderness along left/right ureteral courses. No edema in bilateral lower extremities, NS negative. Outpatient Preliminary Diagnosis: Urinary tract stones; urinary tract infection; renal insufficiency; (right) hydronephrosis with ureteral stone. Treatment Plan: Management: Recommended admission for URL procedure. Medical Record Visit Date: August 23, 09:09 Department: Urology Chief Complaint: Follow-up for previous condition. History of Present Illness: Follow-up visit for previous condition. Abdominal CT, pelvic MRI, routine urinalysis, and urinary system ultrasound have been performed. Physical Examination: Alert and oriented, normal mental status. Soft abdomen, no tenderness or rebound tenderness, no palpable masses. No percussion tenderness over left/right kidney areas, no tenderness at left/right ureteral tender points. Normal bowel sounds. Auxiliary Examinations: Outpatient Preliminary Diagnosis: Urinary tract stones; urinary tract infection. Treatment Plan: 1. Prescription 1: Nitrofurantoin enteric-coated tablets 50.000 mg × 100 tablets/bottle, 1 bottle, oral, twice daily, 2 tablets each time. 2. Prescription 2: Fosfomycin tromethamine granules 3.000 g × 1 box, 5 boxes total, oral, once daily, 1 sachet each time. Management: Follow-up. Discharge Summary Department: Urology Admission Date: August 30, 14:44 Discharge Date: September 2, 08:30 Outpatient Diagnosis: 1. Right hydronephrosis with kidney stones; 2. Status post right ureteral stent placement; 3. Renal insufficiency; 4. Urinary tract infection. Admission Diagnosis: 1. Right hydronephrosis with kidney stones; 2. Status post right ureteral stent placement; 3. Renal insufficiency; 4. Urinary tract infection. Discharge Diagnosis: 1. Right hydronephrosis with kidney stones; 2. Status post right ureteral stent placement; 3. Renal insufficiency; 4. Urinary tract infection. Main Symptoms and Signs on Admission: Chief complaint: Right ureteral stone discovered more than one month ago. Physical findings: Flat and soft abdomen, no local bulging or depression. No tenderness or rebound tenderness, no muscle guarding, no palpable masses. Tympanic percussion note, negative shifting dullness. Bowel sounds 3 times per minute. No percussion tenderness over right or left kidney, no tenderness or percussion pain at bilateral ureteral origins. No lower extremity edema, NS negative. Main Laboratory Results: (September 1, 10:07) Five-part blood differential + CRP: CRP 6 mg/L (0-8 mg/L), white blood cell count 8.72 × 10⁹/L (4.00-10.00 × 10⁹/L), neutrophil% 71.1%↑ (50.0-70.0%), lymphocyte% 22.6%, monocyte% 4.1%, eosinophil% 1.8%, basophil% 0.4%, neutrophil absolute 6.21 × 10⁹/L (2.00-7.00 × 10⁹/L), monocyte absolute 0.35 × 10⁹/L (0.12-0.80 × 10⁹/L), lymphocyte absolute 1.97 × 10⁹/L (0.80-4.00 × 10⁹/L), eosinophil absolute 0.16 × 10⁹/L (0.02-0.52 × 10⁹/L), basophil absolute 0.03 × 10⁹/L (0.00-0.06 × 10⁹/L), red blood cell count 2.95 × 10¹²/L↓ (4.30-5.80 × 10¹²/L), hemoglobin 95 g/L↓ (130-175 g/L), hematocrit 28.30%↓ (40.00-50.00%), mean corpuscular volume 96.0 fL↑ (82.0-95.0 fL), mean corpuscular hemoglobin 32.4 pg (27.0-31.0 pg), mean corpuscular hemoglobin concentration 337 g/L (320-360 g/L), red blood cell distribution width (CV) 14.2%, platelet count 106 × 10⁹/L↓ (100-300 × 10⁹/L), plateletcrit 0.10%, platelet distribution width 16.80 fL, mean platelet volume 10.10 fL; (September 1, 06:52) Procalcitonin + Renal Function - Emergency + Sodium/Potassium/Chloride - Emergency: Sodium (dry chemistry) 134.0 mmol/L↓ (135.0-145.0 mmol/L), potassium (dry chemistry) 5.10 mmol/L (3.50-5.30 mmol/L), chloride (dry chemistry) 103.0 mmol/L (96.0-108.0 mmol/L), urea nitrogen (dry chemistry) 33.0 mmol/L↑ (2.60-7.50 mmol/L), creatinine (dry chemistry) 357.4 umol/L↑ (57.0-111.0 umol/L), uric acid (dry chemistry) 526.50 umol/L↑ (210.00-430.00 umol/L), procalcitonin 0.34 ng/mL; (August 31, 21:38) Sodium/Potassium/Chloride - Emergency: Sodium (dry chemistry) 135.0 mmol/L (135.0-145.0 mmol/L), potassium (dry chemistry) 4.90 mmol/L (3.50-5.30 mmol/L), chloride (dry chemistry) 103.0 mmol/L (96.0-108.0 mmol/L); (August 31, 18:12) Dual Infection Panel - Blue Short: Heparin-binding protein 8.92 ng/mL (0.00-29.40 ng/mL), procalcitonin 0.12 ng/mL; (August 31, 18:06) Sodium/Potassium/Chloride - Emergency: Specimen severely hemolyzed, results for reference only. Sodium (dry chemistry) 131.0 mmol/L↓ (135.0-145.0 mmol/L), potassium (dry chemistry) 6.20 mmol/L↑ (3.50-5.30 mmol/L), chloride (dry chemistry) 102.0 mmol/L (96.0-108.0 mmol/L); (August 31, 16:51) Five-part blood differential + CRP: CRP 5 mg/L (0-8 mg/L), white blood cell count 7.72 × 10⁹/L (4.00-10.00 × 10⁹/L), neutrophil% 65.6%, lymphocyte% 27.5%, monocyte% 5.5%, eosinophil% 0.9%, basophil% 0.4%, neutrophil absolute 5.06 × 10⁹/L (2.00-7.00 × 10⁹/L), monocyte absolute 0.43 × 10⁹/L (0.12-0.80 × 10⁹/L), lymphocyte absolute 1.59 × 10⁹/L (0.80-4.00 × 10⁹/L), eosinophil absolute 0.07 × 10⁹/L (0.02-0.52 × 10⁹/L), basophil absolute 0.03 × 10⁹/L (0.00-0.06 × 10⁹/L), red blood cell count 3.20 × 10¹²/L↓ (4.30-5.80 × 10¹²/L), hemoglobin 107 g/L↓ (130-175 g/L), hematocrit 32.1%↓ (40.00-50.00%), mean corpuscular volume 100.2 fL↑ (82.0-95.0 fL), mean corpuscular hemoglobin 33.5 pg (27.0-31.0 pg), mean corpuscular hemoglobin concentration 334 g/L (320-360 g/L), red blood cell distribution width (CV) 15.4%, platelet count 126 × 10⁹/L (100-300 × 10⁹/L), plateletcrit 0.10%, mean platelet volume 7.94 fL, platelet distribution width 17.09 fL↑; (August 31, 10:14) Blood Type Antibody Screen Identification (Inpatient): ABO blood type A, Rh positive, antibody screen negative; (August 31, 10:09) (Blood Bank) TEG - Routine: R (clotting factor activity) 6.2 min, K (fibrinogen level) 1.2 min, ANGLE (fibrinogen level) 69.0 deg, MA (platelet function) 60.8 mm, CI (comprehensive coagulation parameter) 0.4, EPL (platelet lysis function prediction) 0.00%, LY30 (fibrinolysis function) 0.00%; (August 31, 09:54) Pre-transfusion Testing (no ALT): HIV initial screen negative, HCV-AB-IgG (-) 0.18 s/co, TP-AB (-) 0.15 s/co, HBsAg (-) 0.10 IU/mL, HBsAb (+) 12.89 mIU/mL↑, HBeAg (-) 0.644 S/CO, HBeAb (+) 0.05 S/CO, HBcAb (-) 0.26 S/CO; (August 31, 09:46) PTH: PTH 20.240 pmol/L↑ (1.60-6.90 pmol/L); (August 31, 09:30) Renal Function (with RBP) + Sodium/Potassium/Chloride + GLU + Liver Function - Inpatient: Fibronectin 172.00 mg/L↓ (200.00-400.00 mg/L), glycocholic acid 9.4 mg/L, C1q 184.00 mg/L, prealbumin 124.0 mg/L↓ (200.0-400.0 mg/L), bile acids 8.30 umol/L, alanine aminotransferase 38 U/L, aspartate aminotransferase 47 U/L↑, mitochondrial-AST 12 U/L, alkaline phosphatase 105 U/L, γ-glutamyl transpeptidase 17 U/L, total bilirubin 4.6 umol/L, direct bilirubin 2.2 umol/L, total protein 73.4 g/L, albumin 32.5 g/L↓ (40.0-55.0 g/L), globulin 40.9 g/L↑ (20.0-30.0 g/L), albumin/globulin ratio 0.79↓ (1.20-2.00), AST:ALT 1.24, BUN:CREA 0.10, sodium 130.9 mmol/L↓ (135.0-145.0 mmol/L), potassium 4.97 mmol/L (3.50-5.30 mmol/L), chloride 100.0 mmol/L (96.0-108.0 mmol/L), glucose 5.32 mmol/L, urea nitrogen 35.87 mmol/L↑ (2.60-7.50 mmol/L), creatinine 373 umol/L↑ (57.0-111.0 umol/L), uric acid 543 umol/L↑ (210.0-430.0 umol/L), retinol-binding protein 28.9 mg/L, glomerular filtration rate (MDRD) 13.83 mL/min per 1.73m²; (August 30, 21:47) Routine Urinalysis: Color light yellow transparent, cloudy, urine specific gravity 1.008↓ (1.015-1.025), yeast-like fungi not found, urine pH 5.00↓ (5.00-7.00), urine nitrite positive 1, urine protein 25.00 mg/dL, urine glucose normal mg/dL, urine ketones negative mg/dL, urine urobilinogen normal mg/dL, urine bilirubin negative mg/dL, red blood cell hemoglobin 250/uL↑, leukocyte esterase 500/uL↑, red blood cells (microscopy) 10-15/HP, white blood cells (microscopy) 15-20/HP, epithelial cells (microscopy) not found/HP, crystalline salts (microscopy) not found/HP, hyaline casts not found/LP, granular casts not found/LP, cellular casts not found/LP; (August 30, 17:40) Coagulation Routine: Prothrombin time 13.80 s↑ (9.80-12.10 s), prothrombin time INR 1.20↑ (0.80-1.15), activated partial thromboplastin time 28.6 s (22.7-31.8 s), fibrinogen 3.74 g/L, thrombin time 16.10 s (14.00-21.00 s); (August 30, 17:31) Dual Infection Panel - Blue Short: Heparin-binding protein 6.54 ng/mL (0.00-29.40 ng/mL), procalcitonin 0.08 ng/mL; (August 30, 17:28) Soluble ST2: ST2 160.11 ng/mL; (August 30, 16:54) Five-part blood differential + CRP: CRP 4 mg/L (0-8 mg/L), white blood cell count 7.88 × 10⁹/L (4.00-10.00 × 10⁹/L), neutrophil% 72.3%↑ (50.0-70.0%), lymphocyte% 20.2%, monocyte% 5.9%, eosinophil% 1.0%, basophil% 0.6%, neutrophil absolute 5.69 × 10⁹/L (2.00-7.00 × 10⁹/L), monocyte absolute 0.46 × 10⁹/L (0.12-0.80 × 10⁹/L), lymphocyte absolute 1.59 × 10⁹/L (0.80-4.00 × 10⁹/L), eosinophil absolute 0.08 × 10⁹/L (0.02-0.52 × 10⁹/L), basophil absolute 0.05 × 10⁹/L (0.00-0.06 × 10⁹/L), red blood cell count 3.15 × 10¹²/L↓ (4.30-5.80 × 10¹²/L), hemoglobin 106 g/L↓ (130-175 g/L), hematocrit 31.5%↓ (40.00-50.00%), mean corpuscular volume 99.8 fL↑ (82.0-95.0 fL), mean corpuscular hemoglobin 33.6 pg (27.0-31.0 pg), mean corpuscular hemoglobin concentration 337 g/L (320-360 g/L), red blood cell distribution width (CV) 15.3%, platelet count 132 × 10⁹/L (100-300 × 10⁹/L), plateletcrit 0.11%, mean platelet volume 8.17 fL, platelet distribution width 17.47 fL↑; Special Examinations and Important Consultations: August 31 Digital Radiography: [Findings] Mild inflammation in the right lower lung, right lower lung emphysema; aortic calcification: please correlate with clinical findings. August 30 Computerized Multi-lead Electrocardiogram: [Findings] 1. Sinus bradycardia 2. qRs pattern in V3-V5 (q > 1/4 r; q ≤ 0.04”) 3. Relatively peaked T waves in V3-V5 4. Incomplete right bundle branch block. Tumor Present: No. Course and Treatment Outcome: Relevant examinations completed. Under local anesthesia, right transurethral ureteral/renal pelvis laser lithotripsy and stone extraction performed smoothly, with placement of one right DJ stent. Stent removed prior to discharge. Complications: None. Discharge Status: Alert and oriented, normal mental status, general condition good. Discharge Medications and Recommendations: 1. Rest adequately and drink plenty of fluids. 2. Return to urology outpatient clinic with the original attending physician in two weeks (Monday and Wednesday mornings; Tuesday and Thursday afternoons for urinary stone specialty clinic) for comprehensive reassessment of hydronephrosis and renal function. 3. Advise close follow-up with regular repeat urinary ultrasound, CT, and renal function tests. Treatment Outcome: Recovered. Whole Urinary Tract (Three-Dimensional Reconstruction) Number: 202309 Report Date: September 2 Description: Double J stent visible in right kidney and ureter, multiple punctate high-density shadows in right lower calyx, small round low-density and slightly high-density shadows under right renal capsule, blurred right perirenal fat space. Left kidney markedly atrophied. Bladder poorly distended with balloon shadow inside. Liver normal in morphology and size, uniform parenchymal density, no obvious abnormal density in gallbladder area, common bile duct dilated. Spleen and pancreas normal in morphology and density. Abundant content in colonic lumen. Impression: Status post “right transurethral ureteral/renal pelvis laser lithotripsy and stone extraction,” right urinary system stented, multiple small right kidney stones, possible complex right renal cyst, marked left kidney atrophy. Dilated common bile duct, abundant fecal shadows in colonic lumen, abdominal wall edema. Inpatient Laboratory Report Specimen Type: Urine Department: Nephrology Collection Time: September 9, 08:30 Clinical Diagnosis: Stage 4 chronic kidney disease, urinary tract infection Item | Result | Reference | Unit 1 Color | Yellow | Yellow 2 Clarity | Clear | Clear 3 Urine Specific Gravity | 1.012 | (1.010-1.030) 4 Yeast-like Fungi | Not found | Not found 5 Urine pH | 5.00↓ | (5.4-8.4) 6 Urine Nitrite | Negative | NEG 7 Urine Protein | 25.00 | (<30) | ng/dL 8 Urine Glucose | 50.0↑ | (<50) | ng/dL 9 Urine Ketones | Negative | (<5) | ng/dL 10 Urine Urobilinogen | Normal | (<1) | ng/dL 11 Urine Bilirubin | Negative | (<1) | ng/dL 12 Red Blood Cell Hemoglobin | 50↑ | (<25) | /uL 13 Leukocyte Esterase | 500↑ | (<50) | /uL 14 Red Blood Cells (Microscopy) | 2-4 | (0-3) | /HP 15 White Blood Cells (Microscopy) | 10-20 | (0-5) | /HP 16 Epithelial Cells (Microscopy) | Not found | Not found | /HP 17 Crystalline Salts (Microscopy) | Not found | Not found | /HP 18 Hyaline Casts | Not found | (0-1) | /LP 19 Granular Casts | Not found | Not found | /LP 20 Cellular Casts | Not found | Not found | /LP Laboratory Report Test Time: September 9, 08:42 Report Time: September 9, 09:09 Report Date: September 9 Albumin 30.0 g/L (40-55) Urea nitrogen 30.36 mmol/L (2.86-7.14) Creatinine 285 umol/L (35-97) Uric acid 565 umol/L (208-428) Carbon dioxide 15.0 mmol/L (22-29) Sodium 130.1 mmol/L (135-146) Potassium 5.90 mmol/L (3.5-5.2) Chloride 102.0 mmol/L (96-108) Calcium 1.93 mmol/L (2.196-2.556) Phosphorus 2.03 mmol/L (0.81-1.45) Magnesium 0.94 mmol/L (0.782-1.029) BUN:CREA 0.11 Glomerular filtration rate (MDRD) 18.87 mL/min per 1.73m² Inpatient Laboratory Report Specimen Type: Urine Department: Nephrology Collection Time: September 9, 08:30 Clinical Diagnosis: Stage 4 chronic kidney disease, urinary tract infection Item | Result | Reference | Unit 1 Red Blood Cells | 3.20 | (<10) | /uL 2 White Blood Cells | 87.60↑ | (<12) | /uL 3 Hyaline Casts | 0.00 | (<5) | /uL 4 Pathologic Casts | Negative | Negative 5 Bacteria | 30.00 | (<300) | /uL 6 Non-squamous Epithelial Cells | 1.00 | (<5) | /uL 7 Squamous Epithelial Cells | 0.00 | (<15) | /uL 8 Yeast | Negative | Negative 9 Crystals | Negative | Negative Test Time: September 9, 08:42 Report Time: September 9, 08:46 Date: September 9 Medical Record: Follow-up for chronic kidney disease. Outpatient Preliminary Diagnosis: Stage 4 chronic kidney disease; urinary tract stones; obstructive nephropathy; anemia; hyperkalemia; hyperphosphatemia; hyperuricemia. Outside Hospital: Outpatient follow-up. Treatment Plan: 1. Tests: CO2 combining power; quantitative urine sediment; calcium, phosphorus, magnesium; sodium/potassium/chloride; routine urinalysis; renal function (with RBP); serum albumin; five-part blood differential + CRP. 2. Prescription 1: Sodium bicarbonate tablets 0.500 g × 100/bottle, 2 bottles total [oral] three times daily, 2 tablets each time. 3. Prescription 1: Febuxostat tablets 40.000 mg × 10/box, 3 boxes total [oral] once daily, 1 tablet each time. 4. Prescription 1: Calcium polystyrene sulfonate powder 15.000 g × 1/bottle, 6 bottles total [oral] once daily, 15 grams each time. According to family reports, the patient died several months later.