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Clinical Quiz

Does Past Pathology Predict Future Results?

A 59-year-old man with history of renal cell carcinoma (RCC) presents for urological oncological evaluation after a community urologist discovers a 5.5 cm enhancing renal mass with a nephrometry score of 2+1+3+p+1=7p in his right solitary kidney. He had undergone a left nephrectomy 14 years earlier that revealed a Grade II clear cell RCC. The…

Elderly Man with Anorexia and Acute Renal Failure

A 75-year-old man presented to the emergency department with weakness, anorexia, and nausea, and was found to have acute renal failure with a creatinine of 7.9 mg/dL. Past medical history included non-insulin dependent diabetes, hypertension, coronary artery disease with prior stenting and a more recent bypass graft placement, and low-grade bladder cancer in remission after…

With Bladder Tumors, Size Isn’t Everything

A 45-year-old otherwise healthy male presented to an emergency department with urinary retention. Gross hematuria was demonstrated upon insertion of a Foley catheter. Upon questioning, the man reported that he had intermittent gross hematuria for at least four years. Cross-sectional imaging demonstrated multifocal large tumors filling nearly the entire bladder lumen, with findings confirmed by…

Increased Bleeding from Dialysis Access

A 71-year-old female on hemodialysis three times a week complained of increased bleeding lasting more than 15 minutes from her access, which is in her left upper extremity. She denies any other complaints.For the past four weeks, she has noticed progressively increased bleeding time after her dialysis needles are removed. This access has never been…

Should We Be “Washing-Out” for Adrenal Incidentalomas?

A 55-year-old woman with history of hypertension, melanoma, and urolithiasis is found to have a left adrenal mass on a non-contrast computed tomography (CT) scan evaluation obtained to assess renal colic. The mass measures 2.5 cm in diameter and demonstrates an attenuation of 30 Hounsfield units (HU). A metabolic work-up rules out hypercortisolemia and hyperaldosteronemia.…

African-American Woman with Urinary Frequency, Bladder Discomfort

A 28-year-old African-American woman presented with complaints of urinary frequency and bladder discomfort. She was found to have renal failure (creatinine [Cr] 4.1) and a urine culture was positive for Escherichia coli. She was treated with a full course of antibiotics but renal failure persisted. Medications included occasional nonsteroidals for headache and albuterol for asthma.…

Cystolithiasis in a Man With Painless Gross Hematuria

A robust 80-year-old male on active surveillance for low-risk adenocarcinoma of the prostate developed painless gross hematuria. He reported minimal to moderate lower urinary tract symptoms with an American Urologic Association symptom score of 10 and a quality of life score of 2. He does not use any medications for benign prostatic hyperplasia (BPH). His…

Hispanic Woman Admitted With Left Flank Pain

A 33-year-old Hispanic female was admitted for left flank pain and presumed “pyelonephritis.” The patient had been healthy until two weeks prior to admission, when she noticed her left flank pain. The pain had been present since. The pain seemed to worsen with certain body movements. The patient did not complain of fever, nausea, or…

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