Renal & Urology Flashcards
A 65-year-old male smoker with hypertension, dyslipidaemia, and diabetes mellitus presents with chest pain. ECG changes suggest an acute myocardial infarction. He is taken for an urgent coronary angiogram. Three days later, he is noticed to have developed an elevated serum creatinine, oliguria, and hyperkalaemia.
AKI
A 35-year-old man with a history of congenital valvular heart disease undergoes a dental procedure without appropriate antibiotic prophylaxis. Several weeks later, he presents with fever and respiratory distress. He is intubated, and Streptococcus viridans is isolated in all blood cultures drawn at the time of admission. Echocardiography demonstrates a mitral valve vegetation. Laboratory tests reveal a rising serum creatinine and urine output decline. Urine analysis reveals more than 20 white blood cells, more than 20 red blood cells, and red cell casts. Urine culture is negative. Renal ultrasound is unremarkable. Serum erythrocyte sedimentation rate is elevated.
AKI
A 79-year-old man presents with dyspnoea on exertion for 1 year and lower extremity oedema. As part of a cardiac work-up, the echo shows concentric left ventricular hypertrophy. Cardiac catheterisation shows normal coronary arteries and he is referred for further evaluation of non-cardiac dyspnoea.
Amyloidosis
A 62-year-old man is referred for management of atypical multiple myeloma. He has a mild anaemia of 120 g/L (12 g/dL), a urinary protein loss of 2.2 g/day with a urinary immunofixation showing free lambda light chains. However, the bone marrow shows only 5% plasma cells and does not fulfil criteria for multiple myeloma.
Amyloidosis
A 60-year-old man presents to his primary care physician with a 3-month history of increasing urinary frequency without burning and nocturia 3 times each evening. He has limited his fluid consumption and caffeine intake in the evening without much benefit. There is no personal or family history of prostate cancer. Examination demonstrates no suprapubic mass or tenderness. A rectal examination demonstrates normal rectal tone and a moderately enlarged prostate without nodules or tenderness.
BPH
A 72-year-old man presents with a 6-month history of weak stream, straining, and hesitancy. There is no history of prostate cancer. The physical examination demonstrates a severely enlarged prostate without nodules. There is moderate suprapubic fullness prior to voiding. A urinalysis is normal and the prostate-specific antigen level is 3.0 micrograms/L (3.0 nanograms/mL).
BPH
A 64-year-old man presents with painless haematuria. He had a similar episode 1 year ago and was given antibiotics for a presumed urinary infection and his bleeding resolved. He has a decreased urinary stream and nocturia twice a night. He has smoked a pack of cigarettes daily for 45 years. Physical examination shows only moderate enlargement of the prostate. Urinalysis is positive for 10 to 15 RBCs and 5 to 10 WBCs per high-power field with no bacteria detected.
Bladder cancer
A 54-year-old man with a 10-year history of diabetes and hypertension, with complications of diabetic retinopathy and peripheral neuropathy, presents to his primary care physician with complaints of fatigue and weight gain of 4.5 kg over the past 3 months. He denies any changes in his diet or glycaemic control, but does state that he has some intermittent nausea and anorexia. He states that he has noticed that his legs are more swollen at the end of the day but improve with elevation and rest. Physical examination reveals an obese man with a sitting blood pressure of 158/92 mmHg. The only pertinent physical examination findings are cotton wool patches and micro-aneurysms bilaterally on fundoscopic examination and pitting, bilateral lower-extremity oedema.
CKD
A 21-year-old man presents with a 3-day history of worsening left-sided scrotal pain and swelling. He reports noticing a white urethral discharge over the last 24 hours. He is otherwise fit and well, and takes no regular medicine. He is heterosexual and has a single female partner, with whom he has unprotected intercourse. Examination reveals a tender, erythematous, swollen left hemiscrotum with a palpably thickened epididymis.
Epididymitis
A 74-year-old man with a known history of benign prostatic enlargement and insulin-requiring type 2 diabetes presents with a 7-day history of worsening right-sided scrotal pain and swelling. Initial symptoms of dysuria and frequency have resolved since his family doctor prescribed a course of antibiotics 4 days ago. Examination reveals a tender, swollen right epididymis with an associated hydrocele
Epididymitis
A 35-year-old man with no past medical history presents to the emergency department after he noted cola-coloured urine. He denies pain or fever associated with the bleed, but has had a sore throat for the past 3 days, which is getting better. He has not had a similar episode previously. Examination reveals a non-blanching purpuric rash over both his legs. There are no other abnormalities.
Glomerulonephritis
A 42-year-old man with a medical history of HIV infection presents to his general practicioner with generalised swelling progressive for the past week. HIV was diagnosed a year ago and he has been non-compliant with the therapy prescribed. He denies orthopnoea, abdominal pain, nausea, and blood in his urine. He has non-pitting oedema mostly over the lower extremities but extending up to mid-abdomen.
Glomerulonephritis
A 12-month-old boy presents to his primary care physician with a right scrotal mass. The mass is smaller in the morning than in the evening and increases significantly in size during crying. It gets smaller again when he is lying down. He has no gastrointestinal or urinary symptoms. Physical examination demonstrates normal findings on the left side of the scrotum and a non-tender soft swelling on the right side. The mass is transilluminated when a light is shone on the scrotum, suggesting it is fluid-filled. The right testicle is palpable after gentle pressure reduces the swelling.
Hydrocele
A 48-year-old man presents to his family doctor with a recent lower-extremity swelling that is gradually worsening. Over the last few weeks, he has also noticed puffiness under his eyes. A urinalysis demonstrates significant proteinuria, and a 24-hour urine collection confirms proteinuria of 12 g. He has no history of diabetes, macroscopic haematuria, or hypertension.
Membranous nephropathy (nephrotic syndrome)
A 30-year-old woman with a past medical history of lupus presents to her family doctor with worsening lower-extremity swelling. She has no previous history of renal involvement. A urinalysis reveals 3+ protein and no blood; urinary sediment shows lipid droplets.
Membranous nephropathy (nephrotic syndrome)
