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Clinical Quiz

Heterogeneous Mass Right Adrenal Gland

A Localized Advanced Adrenal Mass in a 61-Year-Old Woman

A 61-year-old white woman experienced progressive right flank pain over a 6-month period. Cross-sectional imaging (computed tomography [CT] of the abdomen and pelvis; MR venogram) demonstrated a 10.9 x 9 x 8.4 cm right adrenal mass with concern for liver invasion and inferior vena cava involvement. Her metastatic workup was negative. She underwent an adrenal…

An ESRD Patient With Arm Swelling

A 52-year-old woman with type 2 diabetes mellitus (DM2), hypertension, and end-stage renal disease (ESRD) due to diabetic nephropathy has been on renal replacement therapy (RRT) for the past 5 years. She was recently transitioned from peritoneal dialysis to hemodialysis (HD) because of frequent peritonitis and subsequent peritoneal membrane failure. There is a tunneled HD catheter…

Microscopic examination revealed the presence of brown crystals

Cryptic CKD in a Man With a Kidney Stone History

A 47-year-old man presented with slowly progressive chronic kidney disease (CKD) of unknown cause. He has a history of passing a kidney stone at age 30. A stone analysis was not performed at that time, and he has had no further stones.  At age 40, his serum creatinine was 1.15 mg/dL; at age 47, the…

CT kidney cystic mass

A 34-Year-Old Man With a Large Right Locally Advanced Renal Mass

A 34-year-old Hispanic-American man initially presented to discuss management of an incidentally detected large locally advanced right solid and cystic renal mass found during an abdominal pain (x 3 days) and early satiety workup. In addition, he was noted to have new small non-painful skin nodules on his trunk and arms that had been present for…

A Patient With Focal Segmental Glomerulosclerosis

A 32-year-old black man was referred to a nephrology clinic for proteinuria. He reported foamy urine for a few months. Urinalysis was positive for protein. He denied any family history of kidney diseases. He was not taking medications except for ibuprofen occasionally for headache. He denied use of tobacco or illicit drugs. Physical examination showed…

A Left Testicular Mass in a 29-Year-Old Man

A 29-year-old white male patient initially presented with a left solid testicular mass found on self-examination. Per the patient, it is painless and has enlarged over a several month period. He has a remote history of a left undescended testicle and orchiopexy at age 6 years. The patient’s tumor markers (AFP, ß-HCG, LDH) were within…

Addition of irreversible electroporation to conventional chemotherapy and radiation therapy in local

An HIV Patient on Chemotherapy With Rising Creatinine

A 72-year-old man was referred to a nephrology clinic because of an increase in creatinine from 1.2 to 2.2 mg/dL. He has a complicated medical history of neurogenic bladder, benign prostatic hyperplasia (BPH), HIV, and metastatic squamous cell carcinoma of the left mandible post resection. He underwent cisplatin-based chemotherapy and radiation 3 years previously. For the…

AKI and New-Onset Proteinuria

A 64-year-old man with past medical history of pre-diabetes, hypertension, benign prostate hyperplasia (BPH), elevated PSA, gastroesophageal reflux disease (GERD), and degenerative joint disease affecting T11 to L1 after extensive back surgery 1 year previously presented with diffuse joint and bone pain the past few months as well as fatigue. He had a rising serum creatinine…

Figure 1. CT abdomen revealing a large complex 16 x 11 x 12cm right anterior cystic renal mass with a calcified rim abutting the right colon.

A 64-Year-Old Woman With a Renal Cystic Neoplasm

A 64-year-old woman underwent a screening colonoscopy at the direction of her primary care physician. The colonoscopy revealed an infiltrative, polypoid, and ulcerated large non-obstructing mass in the mid ascending colon that was biopsy-proven to be a well to moderately differentiated invasive adenocarcinoma. She underwent staging cross sectional imaging that revealed an incidentally diagnosed 16…

Figure 1. Purpuric erythematous rash on patient’s arm.

Acute Kidney Injury in Patient With a Purpuric Rash

A 62-year-old white man with past medical history of ulcerative colitis presented with purpuric rash and abdominal pain that started 4 weeks previously. The abdominal pain was associated with nausea, bloating, episodes of diarrhea, and hematochezia. He stopped taking mesalamine prior to symptom onset. A week earlier, he presented to a local hospital where computed…

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