Mr Smith is a 50 year old man who has recently commenced hospital haemodialysis having developed end-stage renal disease secondary to ADPKD. He has an arteriovenous fistula in place and attends for four-hourly dialysis sessions on a Monday, Wednesday and Friday at his local unit.

His progress is discussed at the monthly dialysis unit meeting.

What parameters can be looked at to see if he is receiving adequate dialysis?

What other laboratory parameters will the dialysis team consider as part of this review?

There will be a mid-week update with more information on this case. Students, add your thoughts to the class discussion boards.

This is the last of the weekly cases for this teaching block, and the last of the renal cases for this year. The next case will be up on June 2nd, and we’ll be starting with a neurology case.

A 55 year old man is seen in the renal clinic following an inpatient stay. During this recent admission under the care of the renal physicians, blood tests revealed that he has advanced renal failure. The cause of his renal disease is not known, but an ultrasound scan as an inpatient showed bilateral shrunken kidneys. It was explained to the patient that he most likely has chronic kidney disease that will progress to end stage renal disease.

He briefly discussed renal replacement therapy with the team on the ward, but is coming now to see you in the renal clinic with his wife to further discuss the options.

How will you approach this discussion and what further information from the patient will help you counsel him about the options available?

IM students, please add your thoughts to the class discussion boards.

A 40 year old woman with end-stage renal disease is admitted to the renal ward complaining of abdominal pain that has gradually worsened over the last 24 hours. The pain is generalised but not severe. She has passed some loose stool, but has had no vomiting.

She has undergone renal replacement therapy in the form of peritoneal dialysis for the last 18 months.

What other points in the history are important?

How will you proceed with investigation and initial management?

Students, please go to the classroom to discuss this case.

A 45 year old man undergoes some tests as part of a routine medical examination. He is found to have microscopic haematuria. He is surprised by this finding as he has had no symptoms. He visits his GP a week later as advised – urine dipstick again shows evidence of haematuria.

What other questions would you like to ask the patient?

How will you proceed with investigating this patient?

IM students, we’ll discuss the case in the classroom this week. We’ll put an update up on Tuesday, so try to get your initial thoughts posted by then.