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Answer 2
  1. Serum analysis to evaluate the level of creatine phosphokinase. A urinalysis that demonstrates large blood on dipstick but no erythrocytes in the sediment represents heme pigment in the urine, typically myoglobin. This finding is most commonly a manifestation of muscle necrosis, or rhabdomyolysis. Statin therapy for hyperlipidemia may be complicated by rhabdomyolysis. Laboratory results in the case of rhabdomyolysis include elevations in serum CPK and urinary myoglobin. Other associated laboratory findings include hyperkalemia and hyperphosphatemia from the release of potassium and phosphorus resulting from damaged myocytes. Hypocalcemia also may develop owing to deposition of the complex of calcium and phosphorus into damaged muscle tissue. An increased serum creatinine concentration signals acute renal failure. In the absence of erythrocytes in the urine, it is unlikely that recurrent stones are present or that a kidney biopsy or cystoscopy would be required to facilitate the correct diagnosis.

     Korbet SM. Percutaneous renal biopsy. Semin Nephrol 2002;22:254-67.

    2. Sutton JM. Evaluation of hematuria in adults. JAMA 1990;263:2475-80.

    3. Topham PS, Harper SJ, Furness PN, et al. Glomerular disease as a cause of isolated microscopic haematuria. Q J Med 1994;87:329-35.

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