Bare-bones case outlines aimed at late-stage medical students and others revising or preparing for nephrological experience.
A patient presents with macroscopic painless haematuria, or microscopic haematuria is discovered incidentally at health screening.
|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)
|A patient presents with oedema, urine shows protein ++++, low JVP, low serum albumin. Aged young or old, and with or without associated disease.|
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.|
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).|
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)
|A patient with recurrent episodes of dysuria and urinary frequency associated with pyuria, with or without fever and loin pain.|
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.