The patient is a 53-year-old male who presented to an outside hospital on 6-2-02 complaining of “dark urine”, pain on urination and abdominal pain for one week. A CT of the abdomen was performed and revealed a possible adrenal mass and a horseshoe kidney. Labs revealed hematuria and a creatinine greater than 2.

	CT scan showing possible adrenal mass
	CT scan showing horseshoe kidney
	Composite of CT scans to show the horseshoe kidney.
	Composite of CT scans to show the horseshoe kidney.
Urinalysis
Specific Gravity	1.013
pH	6
Protein	100
Ketones	Neg
Bilirubin	Moderate
Blood	Large
WBC	Small
Nitrites	Pos
Urine RBC	2905

1. What is your differential diagnosis?

2. Why would he have abdominal pain if he is suffering from a renal process?

3. What further workup would you perform?