Clinical Quiz

Lower Right Abdominal Pain in a Kidney Transplant Recipient

A 70-year-old woman complained of pain in the right lower abdomen in the region of her allograft. She received a decease-donor renal transplant eight years previously. Her native kidney disease was due to diabetes and other medical diagnoses, including hypertension and peripheral vascular disease. Her medications included acarbose, amlodipine, famotidine, lovastatin, liraglutide, metoprolol, prednisone, and…

Approaches to Renal Surgery in the Frail Elderly

An 84-year-old woman who underwent renal biopsy for a right upper pole enhancing 4.3 cm renal mass is considering her surgical options. The mass has demonstrated rapid growth kinetics (8 mm growth in six months) and biopsy revealed clear cell renal cell carcinoma with associated necrosis. The patient enjoys excellent performance status, but has history…

A Pregnant Woman with New Proteinuria

A Hispanic woman in her 20s is referred to nephrology for evaluation of recently discovered proteinuria. She is 16 weeks into her first pregnancy. She has no significant medical history and no specific knowledge of proteinuria. The woman has had lower extremity edema and foamy urine for about the past two weeks. She denies any…

High Complexity T1b Renal Mass in an Elderly Comorbid Patient

An 84-year-old woman with excellent performance status and history of a transient ischemic attack, hypertension, rheumatoid arthritis, bradycardia requiring pacemaker, and an open cholecystectomy with concomitant bowel resection (numerous intraperitoneal metallic clips are evident on the computed tomorgraphy scan) is diagnosed with an incidental enhancing 4.3 cm right upper pole renal mass that has grown…

Autologous Immunotherapy for mRCC Shows Promise

A Young Man with Hypokalemia

A 37-year-old Hispanic man presented to the emergency department with three days of progressive dyspnea and fatigue. He had history of kidney disease since he was very young, including hypokalemia, nephrolithiasis and osteomalacia. His medications included potassium citrate, which he neglected to take for the past week. He has four siblings, one of whom has…

Study Identifies RCC Predictors

Reducing Recurrence after TURBT

A 54-year-old otherwise healthy male was referred for evaluation of hematuria. Upper tract imaging is unremarkable, but local cystoscopy revealed a solitary papillary tumor just lateral to left ureteral orifice. An uneventful transurethral resection of bladder tumor (TURBT) was performed.

TURP Better than PAE for Bladder Outlet Obstruction

An African-American Man with Unexplained Acute Kidney Injury

A 73-year-old African American man complained of generalized fatigue for two weeks, prompting a lab check and subsequent hospital admission by his primary care physician. He denied fevers, vomiting, diarrhea, dysuria, gross hematuria, or use of nonsteroidal anti-inflammatory drugs. He had no abdominal, flank, or back pain and denied any history of nephrolithiasis. There was…

Micropapillary Urothelial Disease in a 61-Year-Old Man

A 61-year-old otherwise healthy man is referred for evaluation of hematuria. A computed tomography urogram reveals a tumor on left lateral wall of the bladder, and the patient undergoes an uneventful transurethral resection. Pathology reveals high-grade urothelial carcinoma with micropapillary features invading the lamina propria (T1). Muscularis propria is present and is uninvolved.

Woman with a Complicated Pregnancy Due to Preeclampsia

A 28-year-old Hispanic woman presented to a nephrology clinic after a complicated pregnancy that resulted in a delivery a few weeks before term due to a diagnosis of preeclampsia.Her ob/gyn wanted her evaluated for a possible underlying chronic glomerulopathy or other kidney disease. This was her third pregnancy and the previous two had been uncomplicated.…

A Testes Cancer Test

A 31-year-old man was found to have a 6 cm left testicular mass and underwent a left radical orchiectomy. Pathology demonstrates pT1 mixed non-seminomatous germ cell tumor. A staging computed tomography scan of the abdomen/pelvis and the CXR are unremarkable. His post-orchiectomy tumor markers are within normal limits.

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