Renal Advice Line

These cases are created from enquiries sent to the Edinburgh Renal Unit’s email clinic.

Cases are listed below.  Via Advanced Search in the right hand menu bar you can narrow the list down by Tags, including Level of Difficulty (You can use the tags to choose by topic and difficulty (A=Learner; B=Practioner; C=Expert), e.g. search on Renal Medicine and Level A).

We’d love to receive more cases.  You will be credited and will contribute to world medical education.  Go to Send a Case.

Resources:  there are links below most of the cases, but the UK CKD eGuide is good for a quick overview and for looking things up. And more at our own edrep.org/resources

Renal Advice Line cases

  • A 44 year old man with previous interstitial nephritis (22) This man was diagnosed with interstitial nephritis secondary to mesalazine (prescribed for ulcerative colitis) in 2009.  His eGFR has remained stable since and is curently 42.  Last year he was started on lisinopril for hypertension but this was stopped some months later as his BP was too low.  The plan then was to reintroduce if ...
  • Anaemia, heart failure and CKD (21) This elderly man has multiple medical problems.  His main current problem is heart failure – he has moderate LV dysfunction, valvular heart disease and pulmonary hypertension.  He is seen by the Heart Failure Nurse and we have reached the point where we agree his treatment is palliative.  He gets recurrent peripheral oedema and ascites.  His ...
  • Anaemia and CKD III (20) This diabetic lady has CKD3 with microalbuminuria of 14.8.  She was recently seen in the haematology clinic regarding her chronic anaemia (most recent haemoglobin was 100g/l).  She was in hospital at the end of last year when she was transfused and started on oral iron.  At that time endoscopy was normal but she has previously ...
  • Anaemia and CKD in the frail elderly (19) This rather frail 85 year old man has recently become anaemic.  His haemoglobin has dropped down to around 9.0 having previously been around the 11 mark.  Haematinics are normal.  His latest renal function shows urea 15.6, creatinine 213, potassium 4.8 and eGFR 26. His general health is poor.  He lives at home and is slowly mobile ...
  • Creatinine rise on losartan (18) A 60 year old lady on losartan and simvastatin had bloods done 3 months ago which showed urea 5.4, creatinine 70 and eGFR 81.  Repeat bloods this week showed urea 5.0, creatinine 138 and eGFR 35.  I advised her to stop her losartan and rechecked it the following day and it improved to urea 5.4, creatinine 81 ...
  • Hypertension, renovascular disease and ACEI (17) This 65 year old lady has a history of resistant hypertension and renal artery stenosis.  She previously had angioplasty to the left renal artery in 1994 and 1997 and had a right renal artery stent inserted in 2002 for an ostial stenosis.  She has been maintained on antihypertensive treatment since, though good control has never ...
  • Optimising an ACEI (16) An 83 year old woman attends the GP surgery for a blood pressure review. Blood pressure has been high for a while (systolic ~160).  She was taking ramipril 1.25mg and diltiazem HCL 360 mg OD.  She had been taking bendrofluazide but this was stopped during a recent hospital admission due to hypokalaemia.   BP a couple of ...
  • Incidental finding of a small scarred kidney (15) A 60 year old lady has recently been found to have a small scarred right kidney.  This was discovered incidentally when having an abdominal ultrasound scan to investigate slightly deranged LFTs.  Her left kidney is normal. The scan was arranged by the dermatologists who have been seeing her because of intermittent facial swelling since June 2008. ...
  • Unilateral cysts as an incidental finding (14) A 79 year old gentleman had an abdominal ultrasound scan due to the incidental finding of abnormal LFTS.  This was reported to show slightly increased echogenicity of the liver in keeping with fatty infiltration.  He was also noted to have small, simple cortical cysts, with the largest measuring 36mm by 31mm, in his left kidney. ...
  • Incidental finding of abnormal renal ultrasound (13) A 47 year old man recently had an ultrasound scan, and the report stated: right kidney could not be identified in the renal bed or right pelvic region. Left kidney =16.6cm, presumably due to compensatory hypertrophy. The left kidney appears normal in echopattern with no hydronephrosis or renal calculi.  He is not aware of having had ...