Renal & Urinary System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S22_F1.jpg"}},{"insert":"\n\n"},{"insert":"What a busy day! You\u0027ve been under a lot of pressure and you\u0027re exhausted.\r\n \r\nYou remind yourself how much you love helping people, and it doesn\u0027t seem so bad.\n"}]}


{"ops":[{"insert":"Your train of thought is interrupted by your assistant announcing that your next patient has arrived.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S22_F3.jpg"}},{"insert":"\n\n"},{"insert":"In comes Steve, a 54 year old man. He explains that he had a discrete episode of gross hematuria yesterday, with mild dysuria and troubling urgency.\n"}]}


{"ops":[{"insert":"Steve adds that this is the first time he\u0027s ever noticed blood in his urine. Further questioning reveals that he has not had fever or flank pain.\r\n \r\nHe can\u0027t think of a trigger for the symptoms, and has not experienced recent trauma to the abdomen.\n\nSteve also tells you that he smokes heavily, but doesn\u0027t drink too much. You estimate his consumption to be around 3 to 4 units of alcohol per week.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S22_F5.jpg"}},{"insert":"\n\n"},{"insert":"You learn that he has had type 2 diabetes for about 5 years, which is well controlled on metformin alone.\r\n \r\nThere is no significant surgical or family history, except for his father also having type 2 diabetes. He is an employee in a small company, with a rural office out in the countryside.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S22_F6.jpg"}},{"insert":"\n\n"},{"insert":"His vitals are as follows: BP: 120\/70 mmHg, pulse: 84 bpm, SpO2: 97% on room air, temperature: 37.1 \u02daC (98.78 \u02daF), BMI: 21.6 kg\/m2.\r\n \r\nThe digital rectal exam shows mild prostate enlargement, without any other abnormalities. The remainder of the physical examination is unremarkable.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S22_F7.jpg"}},{"insert":"\n\n"},{"insert":"His urine analysis report is as follows:\r\n \r\nColor: yellow \r\nTurbidity: clear \r\npH: 5.5 (4.5-8)\r\nSpecific gravity: 1.015 (1.005-1.025)\r\nGlucose, Ketones, Nitrites, Leukocyte esterase, Bilirubin: negative\r\nUrobilinogen: small amount\n\nProtein: negative\r\nRBCs: \u003E50\/hpf (\u22643)\r\nWBCs: 1-2\/hpf (\u22642-5)\r\nSquamous epithelial cells: 10\/hpf (\u226415-20)\r\nCasts: 3-4 hyaline casts\/lpf (0-5)\r\nCrystals: occasionally\r\nBacteria, Yeast: none\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S22_F8.jpg"}},{"insert":"\n\n"},{"insert":"While you are reviewing the report, Steve interjects; \u0022My friend is a nurse, and she told me that using aspirin could have caused something like this. Is that true?\u0022\n\nYou indicate that it is a possible side effect, and ask him how he uses aspirin.\r\n \r\n\u0022I use it as and when if I have a headache. Last week I took it maybe twice or three times in total.\u0022\n\nYou nod and think about your next steps.\n"}]}