Major presentations of diseases
of the urinary tract
Bare-bones case outlines aimed
at late-stage medical students and others revising or preparing
for nephrological experience, from EdREN,
the website of the Renal Unit of the Royal Infirmary of Edinburgh.
To be 'renally competent' you should be
able to deal with and discuss examples of the following 12 case
outlines. All are typical of common or important presentations
of disease that you might encounter on the wards as a junior doctor
or in the community as a General Practitioner. For more detail
on the level of knowledge expected on each diagnosis, and other
things that you might be expected to know, see the detailed knowledge objectives or the full
study
guide (this is within the EEMeC, which is restricted to
Edinburgh University students and staff. Edinburgh teachers, get
a password from your course organiser).
Do you find these TOO EASY? Try the
postgraduate cases ('grey'
cases - more info, less clear diagnosis, more to discuss - but
no answers provided).
Links provided
are usually to other parts of this website but some are outside
links.
| 2.
Proteinuria |
Similar discovery of asymptomatic
proteinuria, in various settings (eg entirely healthy patient,
or patient with other evidence of renal disease).
|
Links: proteinuria
(EdRenINFO), proteinuria
in renal disease (EdRen Handbook),
management
guidelines for proteinuria
(in GP info).
|
| 3.
Oedema (nephrotic syndrome) |
A patient presents with oedema,
urine shows protein ++++, low JVP, low serum albumin. Aged young
or old, and with or without associated disease.
|
Links: nephrotic
syndrome (EdRenINFO).
|
| 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: tests
to do in acute renal failure (EdRenHandbook). Homework:
explain the reason for doing each of these (the answers to some
of these would imply advanced understanding)
|
| 5.
Acute renal failure |
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).
|
Links: 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.
|
Links: UTI
and cystitis (EdRenInfo) and information pages on UTI
|
| 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)
|
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education page
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home page
Note: produced as an educational
resource for doctors and professions allied to medicine, from
the Renal Unit of the Royal Infirmary of Edinburgh. Not intended
for general information: see EdRenINFO
for that. This page last modified in May 2001.