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RENAL UNIT CASE 1 |
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Clinical History: A 52-year-old white male complained of excruciating pain in the left side and left midback. The pain was aching and intermittent and not aggravated by movement. Frequently there was radiation of the pain to the left groin and testis. This was the third or fourth in a series of such episodes, which had been getting progressively worse. He had noticed no abnormalities of the urine and denied dysuria and nocturia. P.E.: Vital signs normal. BP normal. Head and chest normal. No tenderness to palpation or percussion in the back. No bladder distention detectable. No hepatosplenomegaly.
Questions: 1. What is the term usually used to describe this type of pain? What can cause it? 2. How do you interpret the hematuria? 3. What procedures would be in order to evaluate the problem at this point? 4. Figure 1 shows the results of a procedure done to evaluate the patient. What does it show? 5. On the basis of this finding, a surgical procedure was done. Figure 2 and Figure 3 show the findings. What was found in the left ureter? 6. What would you tell the patient about his prognosis? 7. Figure 4 and Figure 5 (5A, 5B, and 5C) show a similar process in the kidney. What manifestations would you predict? Compare this disease with Case 2. 8. The process that we have been studying is most common in what organ? Figure 6. 9. What does the pathologist look for in tissue submitted from lesions of this type? Why? 10. How does the clinician manage patients from whom a single, isolated lesion has been removed? Is urine cytology useful? |
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