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Diabetic Cystopathy with Bilateral Hydronephrosis

  • Jacqueline M. Schulman
    Affiliations
    Aliki Medical Service, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD
    Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Allan C. Gelber
    Correspondence
    Requests for reprints should be addressed to Allan C. Gelber, MD, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F Lord Bldg, Center Tower, Suite 4100, Baltimore, MD 21224.
    Affiliations
    Aliki Medical Service, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD
    Search for articles by this author
Published:February 06, 2018DOI:https://doi.org/10.1016/j.amjmed.2017.12.050
      A 40-year-old man with poorly controlled diabetes mellitus (glycated hemoglobin 19%) with related peripheral neuropathy, nephropathy, and proliferative retinopathy presented with epigastric discomfort, anorexia, polyuria, polydipsia, nausea, and diminished urine output. His longstanding use of insulin was halted in the preceding month owing to termination of employment and loss of health insurance coverage. Examination revealed an afebrile and fully oriented thin man who was hypertensive. He had a distended and diffusely tender abdomen. Laboratory studies identified a serum glucose of 1061 mg/dL. Serum sodium was 121 mmol/L; potassium was 5.0 mmol/L, bicarbonate 23 mmol/L, and serum creatinine was 2.9 mg/dL. Computerized tomography of the abdomen and pelvis revealed massive distention of the urinary bladder, extending 7 cm above the umbilicus with diffuse bladder wall thickening (Figure, panel A), together with moderate bilateral hydronephrosis (Figure, panels B and C) and hydroureter. A diagnosis of diabetic cystopathy with bilateral hydronephrosis was made. A urethral catheter was inserted into our patient's bladder, draining 2 L of urine. Clean intermittent catheterization was advised, with consideration to potential placement of a suprapubic catheter.
      Figure
      FigureComputerized tomography of the abdomen and pelvis, revealing massive distention of the urinary bladder* (A) sagittal view; and hydronephrosis* (B) axial view; (C) coronal view.
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