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Cardiac work-up included a dobutamine stress echocardiogram that showed evidence of reversible ischemia.

High PTH, Phosphorus in a Diabetic Hemodialysis Patient

A 40-year-old man with a history of type 2 diabetes mellitus and hypertension and who had been on hemodialysis thrice weekly for the past 6 months via a left upper extremity arteriovenous fistula developed chronic angina with exertion for 1 week. The patient has been compliant with his dialysis treatment and took calcium acetate 2100…

A PAS statin shows heavy “fuzzy” staining along the glomerular capillary loops

A Woman With Lupus and Nephritis

A 25-year-old Asian woman was diagnosed with systemic lupus erythematosus more than 5 years previously. Her recent systemic symptoms include malar rash, photosensitivity, intermittent alopecia, occasional oral ulcers, and arthralgias involving various joints. She has been on steroids intermittently. She was started on losartan over a year prior and her blood pressure was around 125/70.…

Renal allograft ultrasound showing 2 separate areas of increased echogenicity with shadowing consistent with stones

A Woman With Multiple Kidney Stones

Revisiting a previously discussed case, a 60-year-old woman complained of pain in the right lower abdomen in the region of her kidney allograft.  She had a deceased donor renal transplant 8 years previously. Her native kidney disease was due to diabetes and other medical diagnoses, including hypertension and peripheral vascular disease.  She had a prior episode…

Multiparametric MRI scans of the prostate performed in a patient with high risk prostate cancer.

Appropriate Planning Prior to Prostatectomy

A 63-year-old man with a PSA level of 6.3 ng/mL and a markedly abnormal digital rectal exam (diffuse firm nodularity throughout prostate) underwent 12-core template transrectal prostate needle biopsy, the results of which revealed Gleason 4+4=8 and Gleason 4+5=9 disease in 7 of 12 cores. The patient is motivated to proceed with surgical resection. As…

H&E stain showing diffuse isometric vacuolization of the tubular epithelial cells.

Acute Kidney Injury of the Hydropic Type

A 50-year-old man was admitted with fever, abdominal pain, nausea, a few episodes of non-bloody vomiting, copious diarrhea, and low back pain rated up to 7 out of 10.  His symptoms developed over the past week.  He denied any recent trauma, though had been more physically active in the month prior to illness due to…

Silver stain showing double-contouring in the glomerular basement membrane structure.

A Case of Post-partum Glomerulonephritis

A 27-year-old woman was transferred for a higher level of care. She recently delivered a healthy child at 37 weeks by C-section after presenting to her obstetrician with blood pressure over 160/100 and over 3+ urine albumin on dipstick. She was given a preliminary diagnosis of preeclampsia. Shortly after presentation she developed elevated transaminases, thrombocytopenia…

H&E stain showing a cellular crescent.

Asian Woman with Facial Fullness, Leg Edema

A 30-year-old Asian woman complained of facial fullness and leg edema that developed over the past week. She had no medical history. She was recovering from an upper respiratory illness that began 1 month prior. She had no productive cough, chest pain, or heart disease. She had no dysuria, but did note tea-colored urine through the previous week.  She…

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