Case 23: Introduction

History of Present Illness (HPI)

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A 39 year old man presents to the outpatient nephrology clinic after he was noted to have microscopic hematuria at a routine screening.

He says he’s feeling well today and has no complaints – no headache, fever, nausea, vomiting, chest pain, shortness of breath, abdominal pain, diarrhea, extremity edema, rash, numbness, tingling, hearing loss.  He takes a multivitamin daily and exercises multiple times a week. He notes that he drinks a lot of water as he feels thirsty often and also reports frequent urination.

He tells you his father is a kidney transplant recipient and recently passed away in a motor vehicle accident. He does not know what his father’s kidney disease was. He does not drink alcohol, use tobacco, or illicit drugs.

Before you examine this patient, what’s on your differential diagnosis?
Renal cell carcinoma
Autosomal dominant polycystic kidney disease (ADPKD)
Bladder cancer
Systemic lupus erythematosus (SLE)
Urinary tract infection
Membranous nephropathy
IgA nephropathy
Diabetic nephropathy
Hypertensive nephropathy
Sarcoidosis
Thin basement membrane disease
Alport syndrome
Nutcracker syndrome

Click here for the physical exam!