You are an F2 in GP. James Anderson aged, 30 came to the clinic with a new problem. His eGER low and Creatinine is High Please talk to the patient, discuss plan of management with the patient and address his concerns.
D: Hi I am one the junior doctors in this gp surgery can you confirm me your name and age please
P: yes dr my name is James Anderson I am 30 years old
D: how would you like me to call you?
P: James Is fine dr
D: ok games, What brought you here today?
P: I am losing blood in my urine
D: Could you tell me more about it?
FODIPARA
Frequency, Onset, Duration, Intensity, Progression, Aggravating, Relieving, Associated symptoms
P: It’s been happening for the last couple of days when I pass urine.
D: How much blood did you notice?
P: I don’t know
D: Any blood clots in urine?
P: No
D: Any pain while passing urine?
P: No
D: Any change in your urine color or smell? NO
D: Any fever or flu like illness? NO
D: Do you have to rush to the loo? No ( BPH)
D: Are you going to the loo more often? No
D: Any burning sensation while passing urine? NO (UTI)
D: By any chance have you hurt yourself anywhere? NO
D: any instrumentation in urethra? (TRAUMA)
D: Any pain in your pelvic area? NO
D: Any pain in your tummy? No
D: Any bony pain/? NO
D: Any shortness of breath? NO (ANEMIA)
D: any dizziness or heart racing? NO
D: Any rash or bruise anywhere in the body? NO (BLEEDING DISORDER)
D: Any bleeding from anywhere else? NO.
D: Any change in the color of stool that you noticed? NO
D: do you have any blood disorders?
D: Any lumps or bumps anywhere in the body? NO (CANCER)
D: Any weight loss recently you noticed? NO
D: has anyone told you that you are losing weight? NO
D: How’s your appetite? GOOD
D: Any swelling in the ankles? NO (CKD)
D: Any tingling or numbness in your arms or legs? NO
D: Any nausea or vomiting? NO
D: Is there anything else bothering you?||
P: Dr I have this back pain for around 2 years, but it’s not something new. I have been referred to the specialist for that and they could not find out any cause for it.
D: How are you managing It?
P: I have been taking Ibuprofen almost every day for more than 2 years now.
D: How are you doing in terms of the pain now?
P: Its under control as I am taking the painkillers.
MAFTOSA
D: any similar problem in the past? No
D have you been diagnosed with any medical condition in the past? No
D: By any chance any kidney or bladder problems? No
D: Are you currently on any medication except the painkillers (CYCLOPHOSPHAMIDE AND PENICILLIN BLOOD THINNERS)? No
D: Are you allergic to any medication? No
D: Any family history of any significant health issues or kidney problems? No
D: Do you smoke? No
D: Do you drink Alcohol? No
D: Tell meat about your diet? Balanced
D: Have you travelled anywhere recently? Yes/No
D: Have you ever worked in Aniline, Dyes, Textiles, rubber, plastic or paint industries in the past?
D: Any strenuous exercises recently? (risk factor )
D: do you have any IDEA of whats going on with you? NO
EXAMINATION
I would like to do a GPE, check the BP, PULSE, RR, TEMP and Examine your back. I would like to order initial investigation like routine blood test. Renal function test and Urine dip.
Examiner: BP 145/95
Urine Dip: Protein +; blood+, sediment+,
FBC: Anaemia, WBC increased
MANAGEMENT
From what you have told me and from what we have assessed we suspect you are having a
restrict condition called Analgesics nephropathy. It is a condition that happens due to long term consumption of painkillers resulting in kidney damage.
The mainstay of treatment is to stop taking all the painkillers right away to prevent further damage to the kidneys and may help in the normalization of kidney functions.
(CONCERNS)
P: why this happened to me?
D: long term Use of analgesics.
RISK FACTORS
Use of OTC analgesics, self medications
Taking 6 or more pills a day for at-least 3 years
P: what are you going to do for me?
I will inform my SENIORS who will review you again and we will be REFERRING you to a Kidney specialist for further investigation and treating existing kidney problems.
They may also consider doing a CT SCAN to confirm the diagnosis.
P: will I be alright after the treatment?
The aims of treatment are to prevent further damage and to treat any existing kidney failure
- e.g, with dietary changes, fluid restriction, dialysis or kidney transplant may also be considered in advance stages of the disease. Unfortunately they may not reverse the already established changes in kidneys
P: what about my pain management?
We will be referring you to the pain management team who will help you tackling the long-term pain that you are having. Some behavioral changes or counseling can help to control chronic pain.
COMPLICATIONS: Pyelonephritis, End stage kidney disease
RED FLAGS: Uncontrolled bleeding, unable to pass urine, breathing difficulty or swelling in your body come back immediately
FOLLOW-UP WITH YOUR GP
Leaflets
Specific expectations from this consultation
I wish you a good health.