Could it be renal colic?

CT scan is non-contrast; however, there is:

• right-sided retroperitoneal blood evident
• an abdominal aortic aneurysm

It is important to remember that the commonest cause of the ‘classic’ presentation of renal colic among patients presenting to have a post-mortem is ruptured abdominal aortic aneurysm.

This patient needs an emergency AAA repair.

Biochemistry demonstrates acute renal failure with a reduced urea-to-creatinine ratio.

The likely diagnosis is rhabdomyolysis in this clinical context.

Features suggestive of this diagnosis are:

• increased urea and creatinine with a reduced urea-to-creatinine ratio
• hyperphosphataemia, hypocalcaemia, hyperkalaemia
• metabolic acidosis
• increased CK (usually to greater than 40,000)
• Although not measured here, AST, and LDH are also increased in rhabdomyolysis

Other potential causes:

• hypovolaemia from bleeding
• renal artery occlusion during operation
• use of contrast in pre-operative CT scan (not in this case)
• use of nephrotoxic drugs like gentamicin
• low cardiac output from peri-operative myocardial infarction
• abdominal compartment syndrome