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Core Cases

Educational resources for renal medicine

Licensed under a Creative Commons LicenseCreative Commons Attribution 4.0 International License.

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.

LinksHaematuria (Edren textbook); haematuria (EdRenINFO); 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).

LinksProteinuria (Edren textbook); proteinuria (EdRenINFO); proteinuria in renal disease (EdRen Handbook); management guidelines for proteinuria (in GP info); 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 (EdRenINFO).  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.

LinksGlomerulonephritis 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 (Edrep 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) (Edrep textbook); progression of chronic renal failure (EdRenINFO); 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.

LinksUTI (Edren textbook); edrep extra resource page on UTI; UTI and cystitis (EdRenInfo)

 

 

 

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 (EdRenINFO); Stones (EdRep textbook)

 
Page last modified 14.01.2012, 16:00 by Neil Turner. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.