Dark urine led to a recommendation for kidney biopsy. The patient had abnormal rheumatism markers, and kidney stones were later discovered.
Kidney stones were ultimately discovered
First, the patient's whole family went hiking on a high mountain near the urban area that day. The mountain peak was several hundred meters high, and the patient climbed to the summit. Considering the patient had a family history of autoimmune disease, strenuous hiking should be considered as a possible trigger for autoimmune injury affecting the kidneys, resulting in bloody urine. Second, before visiting the rheumatology outpatient clinic the following week, kidney biopsy should be temporarily deferred. Third, because of the strenuous hiking that day, when the emergency doctor asked about abdominal or back pain, the patient may have attributed any back discomfort to the hiking exertion and responded that there was no discomfort. Therefore, bloody urine itself is an indication for back palpation. Regardless of how the patient responds regarding back discomfort, the doctor should perform palpation. This part is vaguely documented in the emergency medical record, indicating that the emergency doctor did not perform palpation, which does not meet standard practice. Fourth, the daytime high-mountain hike was something the doctors never learned about from start to finish. The patient would not have known it might be related to the dark urine and naturally would not have volunteered the information to the doctors. Fifth, the daytime high-mountain hike was something the patient told this website.
They contacted this website while seeking medical care. Kidney biopsy is not the issue, but what follows a kidney biopsy is often hormone treatment. That path is not an easy one. If they had not contacted this website, the high-mountain hiking factor would not have been incorporated into the diagnostic thinking framework. Then, a small miss could lead to a mile-wide error, and the whole situation would have gone off course.