{"ops":[{"insert":"A 48-year-old male refugee from the Middle East complains of slowly worsening fatigue, sluggishness, and a lack of concentration over a period of three to four years. Careful questioning reveals a history of intermittent vague lower back pain for the same duration.\n\nHe has experienced recurrent episodes of urinary frequency and dysuria since childhood. He says that these were \u0027only treated with pills\u0027, and it appears that they were not investigated further, due to his socioeconomic status. He does not drink but has smoked heavily, to a total of 10 pack years.\n\nA complete blood count is significant for a hemoglobin of 9.6 g\/dL, with a subsequent blood film demonstrating normocytic normochromic anemia. A tuberculin skin test is found to be negative.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-S-071_en.png"}},{"insert":"\n"}]}
2
Investigate
Ultrasound abdomen
{"ops":[{"insert":"The ultrasound scan reveals a small right kidney, measuring 6x3x2 cm (normal: 11x7x3 cm), with an irregular echotexture, cortical scarring, and an echogenic parenchyma. A staghorn calculus is visualized in the right pelvis, with hydronephrosis.\n\nThe left kidney appears normal. There are no perirenal fluid collections or obvious anatomic abnormalities of the genitourinary system.\n"}]}
Urinalysis + Urine Cultures
{"ops":[{"insert":"RBC: 2-3\/hpf (2-3)\nPus cells: 50-60\/hpf (0-4)\nWBC casts: present\nNitrates: negative\nProteins: 1+\nCultures: positive for Proteus spp., sensitive to ampicillin and cephalosporins.\n"}]}
