A young woman attends the clinic with a 3 day history of peeing more often and discomfort peeing.
What initial tests do you do?
1) You find she has blood, protein, leucocytes and nitrites in her urine. What is the likely diagnosis and what would you do next?
You’d want an MSSU for culture & Sensitivities
1) How would you treat her UTI?
Trimethoprim is the standard Abx for UTI. Alternatives exist e.g. nitrofurantoin
1) What else would you want to know before picking an antibiotic for her?
If shes pregnant. Trimethoprim is teratogenic.
2) A young man presents with red urine and a 2 day history of a sore throat. On exam he hes hypertensive and a dipstick shows blood and protein in his urine. Whats he likely got?
The hypertension and blood sounds like Nephrritic syndrome
Could be post-infective GN but that takes 7-14 days after infection not 2.
Most likely its IgA GN
2) How would you confirm your diagnosis?
Preceeded by US & Coagulation screen
2) How would you treat?
ACEI for the hypertension Supportive Therapy (including monitor progression of disease)
3) Elderly male presents with 4 wks of painless frank haematuria. Whats the likely diagnosis?
Painless frank haematuria in the elderly is Bladder Cancer until proven otherwise
3) How would you investigate?
-> If bladder cancer biopsy to confirm
3) How do you continue if theres no visible bladder canceR?
CT-KUB to check for a higher up cancer
4) 10 yrd old boy comes in with facial & eyelid swelling, ankle swelling and frothy urine. On urine dipstick he has protein in his urine. Whats the likely diagnosis?
Well Oedema & protein in urine indicates nephrotic syndrome.
Nephrotic syndrome in a kid is minimal change disease until proven otherwise
4) how do we confirm/treat the diagnosis?
With a renal biopsy (but if were sure we don’t biopsy every 10 yr old)
Steroids for treatment
5) 71 yr old female presents with 3 wks of fever, anorexia, malaise and rigors. Initial bloods show:
- Low Hb
- High WCC
- High Platelets
- Very High ESR
- High Creatinine
- High Urea
- Low Albumin
- High Alk Phos
What would be your initial tests?
5) Initial investigations are all normal bar small pleural effusions on CT chest.
How would you respond?
Treat with Abx.
5) Abx had no effect how would you further investigate?
5) Urinalysis shows severe haematuria and proteinuria.
What does this suggest and how do you respond?
Coupled with the hypertension and signs of renal insufficiency this suggests nephritic syndrome
Do a renal biopsy
5) Renal Biopsy shows Focal Necrotising GN. How do you treat?
Cyclophosphamide & Prednisalone