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What are the three most likely causes of dark brown urine in a woman?

Acute tubular necrosis``


What investigations are done to assess renal status?

Dipstick of urine - blood, protein. MSU - exclude urine infection; find out if urine suggests
nephritis - RBCs in urine, red cell cast

Serum creatinine and urea - exclude acute renal failure

Serum sodium and potassium - exclude hyperkalemia which may be urgently life

Ultrasound of kidneys - ensures no evidence of CKD, exclude severe parenchymal renal
infection, abscess


What investigations are done to assess infection?

Haemoglobin - normochromic anaemia
White cell count and differential - neutrophilia - but not specific for infection
Blood culture
Chest radiograph - pneumonia can occur without physical sign
CRP - along with other acute phase proteins not diagnostic; often raised in immune
disease, higher in infection
MSU and blood cultures [repeated] - no growth
Hb 100.5 g/L, WCC 16x109/L - 90% neutrophils CxR – normal


How can lupus be investigated?

Anti nuclear antiboidies
Low C3 and C4


What physical signs are compatible with volume depletion?

sunken eyes
dry nose or mouth mucous membrane
longitudinal furrows on the tongue