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Page 1: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 2: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Your next patient is a woman in her mid 30’s.She complains of patient in her lower back,

radiating to her right flank and down into the groin.

What else would you like to know?

Page 3: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

DDx’s.

Page 4: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

How will you proceed.

Page 5: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

The patient asks what the stone is made of and why she got the stone.

Page 6: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

From her bloods you see that her calcium is quite high. You wonder why this is.

Page 7: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Upon ultrasound the ureter is dilated, but no stone is found. Looking at the kidney there is an obvious mass, that is clearly not cystic.

Page 8: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

The patient asks if it could be cancer. What tumours are found in the kidney?

Page 9: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

A CT-guided biopsy is undertaken. You take the sample up to the pathologist.

Page 10: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 11: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

What is her prognosis? How does this compare to the prognosis of the other RCCs?

Page 12: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

The patient asks you if any of her 8 children will be at risk of cancer. Are they? What about the other types of RCC?

Page 13: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Your patient then tells you that she was considering donating a kidney to her mother who has ESRD.

Page 14: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Stage 1: kidney damage with normal or high GFR (>90) Mild CKD 6.5% prevalence Asymptomatic

Stage 2: kidney damage and GFR 60-89 Stage 3:

3A – GFR 45-59 3B – GFR 30-44 Moderate CKD 4.5% prevalence Usually asymptomatic, anaemia in some patients at 3B, most are non-progressive or

progress very slowly Stage 4: GFR 15-29

Severe CKD Prevalence 0.4% First symptoms often at GFR < 20. Electrolyte problems likely as GFR falls

Stage 5: GFR < 15, or on dialysis Kidney failure Significant symptoms and complications usually present. Dialysis initiation varies but

usually at GFR < 10

What are the stages of CKD?

Page 15: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

What are the options available to the patients mother?

Page 16: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

AbsoluteActive malignancy – at least 2 yrs of complete

remission for most tumoursActive vasculitis or recent anti-GBM diseaseSevere heart diseaseSevere occlusive aorto-iliac vascular disease

RelativeAge – not routinely offered to < 1 yo, or > 75 yoHigh risk of disease recurrence in the transplant

kidneyDisease of the lower urinary tract Significant comorbidity

What contraindications are there to renal transplantation?

Page 17: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Compare the different types of dialysis.

Page 18: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Your patient mutters something about her mother having hyperparathyroidism and being anaemic. Explain how hyperparathyroidism can be caused by CKD.

How would you manage the hyperparathyroidism.

Why is she anaemic?How would you manage the anaemia.

Page 19: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

CVD Acidosis Fluid and electrolyte balance Cellular and humoral immunity are impaired in CKD Infections are the 2nd most common cause of death in dialysis

patients after CVD Increased bleeding tendency – cutaneous ecchymoses, mucosal

bleeds Generalised myopathy –poor nutrition, hyperparathyroidism, vit D

deficiency, disorders of electrolyte metabolism Restless leg syndrome Both sexes – loss of libido, sexual function -> hyperprolactinaemia GIT – anorexia, nausea, vomiting, higher incidence of peptic ulcer

disease Depression also an issue

What other adverse effects are associated with CKD?

Page 20: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Your patient mentions that her mother is diabetic. What are the other common causes of CKD.

Congenital and inherited (5%) – polycystic kidney etc

Renal artery stenosis (5%)Hypertension (5-20%)Glomerular diseases (10-20%) – IgA nephropathy

is the most commonInterstitial disease (20-30%) Systemic inflammatory disease (5-10%) – SLE,

vasculitisDiabetes mellitus (20-40%)Unknown (5-20%)

Page 21: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

What are the mechanisms behind diabetic nephropathy?

Mesangial explansion, thickening of the GBM, glomerular scleroris (intraglomerular hypertension).

Page 22: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

The mother comes in the next day in a coma. What other symptoms are associated with ESRD?

Page 23: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

Pathology image recognition time

Page 24: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 25: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 26: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 27: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 28: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 29: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 30: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 31: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 32: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 33: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else
Page 34: Your next patient is a woman in her mid 30’s. She complains of patient in her lower back, radiating to her right flank and down into the groin. What else

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