Clinical Cases

Question 1

1)
A young woman attends the clinic with a 3 day history of peeing more often and discomfort peeing.
What initial tests do you do?

Answer 1

Urine Dipstick

Question 2

1) You find she has blood, protein, leucocytes and nitrites in her urine. What is the likely diagnosis and what would you do next?

Answer 2

A UTI

You’d want an MSSU for culture & Sensitivities

Question 3

1) How would you treat her UTI?

Answer 3

Trimethoprim is the standard Abx for UTI. Alternatives exist e.g. nitrofurantoin

Question 4

1) What else would you want to know before picking an antibiotic for her?

Answer 4

If shes pregnant. Trimethoprim is teratogenic.

Question 5

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?

Answer 5

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

Question 6

2) How would you confirm your diagnosis?

Answer 6

Renal Biopsy

Preceeded by US & Coagulation screen

Question 7

2) How would you treat?

Answer 7

ACEI for the hypertension
Supportive Therapy (including monitor progression of disease)

Question 8

3) Elderly male presents with 4 wks of painless frank haematuria. Whats the likely diagnosis?

Answer 8

Painless frank haematuria in the elderly is Bladder Cancer until proven otherwise

Question 9

3) How would you investigate?

Answer 9

Cystoscopy:

-> If bladder cancer biopsy to confirm

Question 10

3) How do you continue if theres no visible bladder canceR?

Answer 10

CT-KUB to check for a higher up cancer

Question 11

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?

Answer 11

Well Oedema & protein in urine indicates nephrotic syndrome.
Nephrotic syndrome in a kid is minimal change disease until proven otherwise

Question 12

4) how do we confirm/treat the diagnosis?

Answer 12

With a renal biopsy (but if were sure we don’t biopsy every 10 yr old)
Steroids for treatment

Question 13

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
Slightly hypertensive

What would be your initial tests?

Answer 13

Sigmoidoscopy
Ba Enema
ERCP
CT Thorax/Abdo

Question 14

5) Initial investigations are all normal bar small pleural effusions on CT chest.
How would you respond?

Answer 14

Treat with Abx.

Question 15

5) Abx had no effect how would you further investigate?

Answer 15

Urinalysis

Question 16

5) Urinalysis shows severe haematuria and proteinuria.

What does this suggest and how do you respond?

Answer 16

Coupled with the hypertension and signs of renal insufficiency this suggests nephritic syndrome

Do a renal biopsy

Question 17

5) Renal Biopsy shows Focal Necrotising GN. How do you treat?

Answer 17

Cyclophosphamide & Prednisalone