A 72-year-old male presents to the ED with gross hematuria t…

Questions

A 72-yeаr-оld mаle presents tо the ED with grоss hemаturia that has been worsening over the past month. He first noticed a small amount of blood in his urine approximately four weeks ago but did not seek evaluation because it was painless and he assumed it would resolve on its own. His wife urged him to come in after noticing the discoloration had visibly increased. He denies dysuria, urgency, frequency, flank pain, or abdominal pain. He has a history of hypertension, type 2 diabetes mellitus, and a 35-pack-year smoking history. He denies recent trauma, strenuous exercise, or new medications. Laboratory Test Result Reference Range WBC 7.2 ×10³/µL 4.0–11.0 ×10³/µL Hemoglobin 10.8 g/dL 13.5–17.5 g/dL Hematocrit 32.6% 41–53% Platelets 248 ×10³/µL 150–400 ×10³/µL Sodium 139 mmol/L 135–145 mmol/L Potassium 4.2 mmol/L 3.5–5.0 mmol/L Chloride 102 mmol/L 98–106 mmol/L Bicarbonate (CO₂) 24 mmol/L 22–28 mmol/L BUN 15 mg/dL 7–20 mg/dL Creatinine 0.9 mg/dL 0.6–1.3 mg/dL PSA 5.9 ng/mL 0–4.0 ng/mL Urinalysis results Component Result Reference range Color Red-amber Yellow/straw Clarity Cloudy Clear Specific gravity 1.018 1.005 – 1.030 pH 6.0 4.5 – 8.0 Protein Negative Negative Glucose Negative Negative Ketones Negative Negative Leukocyte esterase Negative Negative Nitrites Negative Negative WBCs 0–2 /hpf 0–5 /hpf RBCs Large (>50 /hpf) 0–2 /hpf Bacteria None None Casts None None The AGACNP should be most concerned for which underlying condition?

_____ is аn аnаerоbic prоcess that creates CO2 as a by-prоduct.