Clinical Quiz

Acute Interstitial Nephritis With Granuloma Formation

A 51-year-old African American male with a history of tobacco use, hypertension, gastroesophageal reflux disease, and benign prostatic hyperplasia, is found to have an elevated Creatinine on a routine visit. He has no cough, fever, dyspnea, chest pain, abdominal pain or any lower urinary tract symptoms. Medications include Amlodipine, Terazosin, Pantoprazole, and Budesonide/ formoterol formoterol…

2.4 cm right renal mass

A Caucasian Man With a Right Renal Mass

A 53-year-old Caucasian man initially presented to discuss management options for an incidentally noted and mildly enhancing (24 to 50 Hounsfield units) 2.4 cm right renal mass (circled region in image) found during a workup for abdominal pain. After discussing treatment options, the patient elected to proceed with a robotic partial nephrectomy for definitive management. 

Figure 1. CT abdomen of this patient shows three radio-opaque stones in the left kidney.

An Asian Man With Recurrent Kidney Stones

A 60-year-old Asian man with history of recurrent nephrolithiasis, congenital solitary left kidney, gout, hypertension, pre-diabetes was seen in nephrology clinic. Since his 20’s, he has had multiple lithotripsy and ureteral stenting procedures to remove stones and to relieve hydronephrosis. He has a strong family history of kidney stones and gout. His creatinine was 1.5…

ADPKD in a Young Woman Contemplating Pregnancy

A 24-year-old woman came to a renal clinic for evaluation of autosomal dominant polycystic kidney disease (ADPKD). Her mother has ADPKD and is currently on dialysis. One of her sisters also has ADPKD. She recently went to the local health fair where she was found to have kidney cysts by ultrasound. A subsequent formal kidney…

Kidney Disease in a Croatian Immigrant

A 48-year-old man with no medical history presented to the clinic complaining of progressive fatigue over the past year. He denied any other constitutional symptoms such as fever, weight loss, and night sweats. He emigrated from Croatia 5 years previously and has not seen a physician since. He has never taken any medications, and he…

Obese man sitting in doctor's office

Hypogonadism in Reproductive Years

An obese 43-year-old male presents for evaluation of primary infertility and loss of libido. His wife is 37 and has regular periods but has moderate premature ovarian failure. Aside from the obesity, the physical examination was within normal limits. Laboratory findings are as follows: Testosterone 103 ng/dL (normal 300-900ng/dl) Estradiol 54  (normal range less than…

Secondary Hyperparathyroidism in Hemodialysis Patients

A 55-year-old African-American man with a history of hypertensive nephrosclerosis who has been on hemodialysis (HD) for the past 7 years was doing dialysis rounds. On physical exam he was well appearing, BP was 138/90 mm Hg, and his pulse was 84 bpm. He had no lower extremity edema and no rashes or skin lesions.…

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…

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