Core Cases

Bare-bones case outlines aimed at late-stage medical students and others revising or preparing for nephrological experience.

1. Haematuria

A patient presents with macroscopic painless haematuria, or microscopic haematuria is discovered incidentally at health screening.

Links:  Haematuria (Edren textbook); haematuria (EdRen INFO); management guidelines (EdRen GPinfo) for microscopic and macroscopic haematuria;  Haematuria from the UK CKD eGuide (www.renal.org/ckd)


2. Proteinuria

Similar discovery of asymptomatic proteinuria, in various settings (eg entirely healthy patient, or patient with other evidence of renal disease).

Links:  Proteinuria (EdRen textbook); proteinuria (EdRen INFO); proteinuria in renal disease (EdRen Handbook); management guidelines for proteinuria (EdRen GPinfo); Proteinuria from the UK CKD eGuide (www.renal.org/ckd)


3. Oedema

A patient presents with oedema, urine shows protein ++++, low JVP, low serum albumin. Aged young or old, and with or without associated disease.

LinksOedema and nephrotic syndrome (EdRen textbook) nephrotic syndrome (EdRen INFO).  Nephrotic syndrome (EdRen handbook).    A 2-year old girl with oedema (Malawi cases)


4. Acute renal inflammation

A short illness with renal impairment, often hypertension, maybe with overt fluid retention, possibly with haematuria and proteinuria if caused by glomerulonephritis, less of this if caused by interstitial inflammation.

Links:  Glomerulonephritis and interstitial nephritis (EdRen textbook). Homework: explain the reason for doing the tests to do in acute renal failure (the answers to some of these would imply advanced understanding).  Glomerulonephritis and Interstitial nephritis (EdRen INFO). A 15 year old with oedema (and similar cases; Virtual Clinic)


5. Acute renal failure (Acute kidney injury)

Oliguria and rising serum creatinine and urea arising in the community or in hospital as part of an acute illness.

Links: ARF (AKI) (EdRen textbook).  Management of ARF (EdRen handbook).  ARF (AKI) for patients (EdRen INFO).  AKI Cases – test yourself and learn with these (EdRen Resources)


6. Chronic renal failure (probable)

A patient presents with tiredness and is found to be hypertensive (175/110). There are minimal or no other features but they are found to be anaemic (Hb 100) and serum creatinine is 347 micromols/l (probable chronic renal failure).

Links: CKD 1-3 and CRF (CKD 4-5) (EdRen textbook); progression of chronic renal failure (EdRen INFO); blood pressure in renal disease (EdRen Handbook)

7. Simple fluid and electrolyte disturbances

Involving disordered volume status, potassium, sodium, calcium, and their emergency management or non-urgent management as appropriate.

Links: emergency management of hyperkalaemia (EdRen Handbook)


8. UTI

A patient with recurrent episodes of dysuria and urinary frequency associated with pyuria, with or without fever and loin pain.

Links:  UTI (EdRen textbook); EdRen Resource page on UTI; UTI and cystitis (EdRen INFO)

Our info sources are less comprehensive for these last four Mostly-Urology cases.  Sorry about that. 


9. Lower urinary tract symptoms

In the absence of urinary infection. In females and in males, at different ages.

Links: Recent advances: Urology, P Abrams, A Wein, Br Med J 2000;321:1393-1396, Fluctuation in LUTS in women, S Hunskaar, Br Med J 2000;320:1418-1419; Benign prostatic hyperplasia: extracts from ‘Clinical Evidence’, MJ Barry, CG Roehrborn, Br Med J 2001 323:1042-6; all these three available from eBMJ (go down to search by citation for quickest access) Prostatic enlargement from NIDDK (USA).


10. Prostatic carcinoma

During rectal examination, performed because a patient has iron deficiency anaemia, you suspect that the prostate gland feels hard.

Links: Prostatic carcinoma ….. Screening for prostate cancer in the UK, JL Donovan et al, Br Med J 2001;323:763-764, available from eBMJ (go down to search by citation for quickest access).


11. Testicular tumours

A man is his twenties finds a lump in his testis.

Links: Managing testicular cancer, DP Dearnaley et al, Br Med J 2001 322:1583-8 available from eBMJ (go down to search by citation for quickest access)


12. Loin pain (renal stones)

A patient with a second episode of acute and severe loin pain, radiating to the groin, associated with haematuria.

Links:  Kidney stones (EdRen INFO); Stones (EdRen textbook)