Bare-bones case outlines aimed at late-stage medical students and others revising or preparing for nephrological experience.
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 (EdRenINFO); proteinuria in renal disease (EdRen Handbook); management guidelines for proteinuria (in GP info); 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.