Bring the lecture to the bedside — Day 3

Urine, protein and glomerular syndromes

Andrew Bland, MD, FACP, FAAP · October 21, 2026

Self-study and additional cases · Day 3

4 cases now use the same sequence, with 28 short lessons and opening, interpretation and treatment figures.

Open the collected self-study teaching ↓ · Browse the self-study case guide

Teach Day 3 from one place

Opening frameworks, 35 Learn first sections, stage-specific infographics and direct lecture links for the three classroom cases. Use the short lesson before its question, then return to the case to commit, discuss and reveal.

Session plan and self-study cases · Shared opening lecture · Day 3 figures in the visual library

Treat urgent threats while you evaluate

Look for sepsis, rapidly progressive kidney dysfunction, pulmonary–renal features, dangerous hypertension and nephrotic complications. Distinguish contaminated urine or asymptomatic bacteriuria from a clinical infection.

Four urgent assessment domains: heart, brain, breathing and perfusion, and kidney/metabolic threats; stabilize and investigate in parallel, then reassess.
· Download PNG · Download Markdown · Read text and evidence

Name the threat, begin indicated treatment, investigate in parallel, then reassess.

Case 07: The Grandmother's Urine Cup

Teach the staged case →

Start with the approach, then build the case

First decide whether the specimen and symptoms fit. Then separate urinary infection, contamination, medication effects and water-balance disorders.

2 · Findings

Revisit urgency as history, examination and initial data arrive.

Open this stage →

3 · Lab interpretation

Use the urine, blood or imaging guide at the relevant decision.

Open this stage →

4 · Treatment and reassessment

Connect the management plan with response, monitoring and follow-up.

Open this stage →

Opening visual framework

A screening pad points to a next question. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Lab interpretation guide

Schematic hyaline, muddy brown granular, red-cell and white-cell casts, with their common clinical associations and a separate section on squamous epithelial cells and possible specimen contamination.
· Download PNG · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Treatment and reassessment guide

Thiazides impair urinary dilution; low solute intake, excess water, and sometimes volume depletion contribute to hyponatremia. Postoperative pain, nausea, and medications can sustain ADH activity while hypotonic intake adds water. Lithium can impair collecting-duct response to ADH, producing dilute polyuria and hypernatremia when losses exceed intake.
· Download PNG · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Learn first · all 11 decision primers
All relevant lecture connections for this case

Return to the lecture topics

Assigned reading: the explanations in this case and the question-linked course evidence guide. The objective map distinguishes tested decisions from concepts taught in explanations.

Concepts: aki-06, aki-27, ckd-18, glom-01, glom-02, lytes-01, lytes-06, structural-04, structural-05, structural-14, structural-18, structural-25.

Case 08: The Sore Throat That Came Back

Teach the staged case →

Start with the approach, then build the case

Confirm and locate hematuria, recognize a nephritic pattern, and use the tempo of kidney and lung findings to set the urgency.

2 · Findings

Revisit urgency as history, examination and initial data arrive.

Open this stage →

3 · Lab interpretation

Use the urine, blood or imaging guide at the relevant decision.

Open this stage →

4 · Treatment and reassessment

Connect the management plan with response, monitoring and follow-up.

Open this stage →

Opening visual framework

Different barrier injuries produce different urine clues. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Lab interpretation guide

Urine particles can help localize injury. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Treatment and reassessment guide

Are complications refractory to medical treatment?. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Learn first · all 12 decision primers
All relevant lecture connections for this case

Return to the lecture topics

Assigned reading: the explanations in this case and the question-linked course evidence guide. The objective map distinguishes tested decisions from concepts taught in explanations.

Concepts: aki-01, aki-02, aki-22, aki-24, glom-02, glom-03, glom-06, glom-07, glom-12, glom-13, glom-14, glom-15, glom-16, glom-17, glom-23, htn-cardiorenal-08, htn-cardiorenal-17.

Case 09: The Diabetic Journey

Teach the staged case →

Start with the approach, then build the case

Quantify albumin, describe the glomerular syndrome, and connect edema and complications with the evolving kidney trajectory.

2 · Findings

Revisit urgency as history, examination and initial data arrive.

Open this stage →

3 · Lab interpretation

Use the urine, blood or imaging guide at the relevant decision.

Open this stage →

4 · Treatment and reassessment

Connect the management plan with response, monitoring and follow-up.

Open this stage →

Opening visual framework

Albumin moves from blood across the glomerular barrier into filtrate, with proximal tubular reclamation. UACR divides urine albumin by urine creatinine. KDIGO A3 above 300 mg/g is subdivided for teaching into greater than 300 through 1,000, greater than 1,000 through 3,000, and greater than 3,000, called A4 in Bland’s teaching framework. All three remain KDIGO A3.
· Download PNG · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Lab interpretation guide

Glomerular barrier injury permits protein loss into urine. Albumin loss and renal sodium retention contribute to edema. Altered coagulation and urinary protein losses increase thrombosis risk; immune protein losses and treatment affect infection risk. Altered hepatic production and lipid clearance cause hyperlipidemia.
· Download PNG · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Treatment and reassessment guide

Heart failure: venous congestion impairs sodium excretion. Nephrotic syndrome: albumin loss and renal sodium retention contribute to edema. Cirrhosis: splanchnic vasodilation reduces effective arterial filling and activates sodium and water retention. These processes can overlap.
· Download PNG · Download Markdown · Read text and evidence

Use the diagram with the teaching text, then apply it to the case findings.

Learn first · all 12 decision primers
All relevant lecture connections for this case

Return to the lecture topics

Assigned reading: the explanations in this case and the question-linked course evidence guide. The objective map distinguishes tested decisions from concepts taught in explanations.

Concepts: ckd-06, ckd-09, ckd-12, ckd-13, ckd-17, ckd-21, ckd-22, ckd-23, ckd-24, ckd-25, glom-04, glom-05, glom-07, glom-10, glom-11, glom-18, glom-19, glom-20, glom-21, glom-22, glom-23, glom-24, structural-23, structural-26.

Return to the week

Day 1Day 2Day 3Day 4Day 5

Bring the lecture to the bedside · Course evidence guide · Integrated case summaries

Self-study and additional cases · Day 3

Open a case below for its teaching, diagrams and lecture links. Use the staged case to answer the questions and reveal explanations.

Case 23: The Resistant Heart Failure · 7 short lessons

Open the staged case →

Approach → findings → interpretation → treatment

Follow the edema circulation pathway before accepting a heart-failure label. Quantify protein, assess the glomerular syndrome and watch for complications.

2 · Findings

Build the pattern as the history, examination and results arrive.

Open this stage →

3 · Lab interpretation

Use the mechanism to explain the blood, urine or imaging findings.

Open this stage →

4 · Treatment and reassessment

Connect the treatment with the response, risks and follow-up.

Open this stage →

Review the shared urgent-threat framework →

Opening visual framework

Heart failure: venous congestion impairs sodium excretion. Nephrotic syndrome: albumin loss and renal sodium retention contribute to edema. Cirrhosis: splanchnic vasodilation reduces effective arterial filling and activates sodium and water retention. These processes can overlap.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Lab interpretation guide

Different barrier injuries produce different urine clues. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Treatment and reassessment guide

Glomerular barrier injury permits protein loss into urine. Albumin loss and renal sodium retention contribute to edema. Altered coagulation and urinary protein losses increase thrombosis risk; immune protein losses and treatment affect infection risk. Altered hepatic production and lipid clearance cause hyperlipidemia.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Learn first · decision primers

Explain the whole case

How does the edema pathway lead to urine protein testing, and what new symptom would trigger urgent reassessment?

All relevant lecture connections

Return to the lecture topics

Assigned reading: the explanations in this case and the question-linked course evidence guide. The objective map distinguishes tested decisions from concepts taught in explanations.

Concepts: aki-03, glom-04, glom-07, glom-10, glom-18, glom-19, glom-20, glom-21, glom-23, glom-24, lytes-07, structural-20.

Case 24: The Two Swollen Cousins · 7 short lessons

Open the staged case →

Approach → findings → interpretation → treatment

Use pediatric thresholds for the child, then compare the adult’s cause-specific pathway. A shared nephrotic phenotype does not imply the same lesion or treatment.

2 · Findings

Build the pattern as the history, examination and results arrive.

Open this stage →

3 · Lab interpretation

Use the mechanism to explain the blood, urine or imaging findings.

Open this stage →

4 · Treatment and reassessment

Connect the treatment with the response, risks and follow-up.

Open this stage →

Review the shared urgent-threat framework →

Opening visual framework

Interpret BP within the child’s reference framework. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Lab interpretation guide

Focal describes which glomeruli; segmental describes how much. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Treatment and reassessment guide

Glomerular barrier injury permits protein loss into urine. Albumin loss and renal sodium retention contribute to edema. Altered coagulation and urinary protein losses increase thrombosis risk; immune protein losses and treatment affect infection risk. Altered hepatic production and lipid clearance cause hyperlipidemia.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Learn first · decision primers

Explain the whole case

Why can two patients with nephrotic syndrome need different investigations and treatments?

All relevant lecture connections

Return to the lecture topics

Assigned reading: the explanations in this case and the question-linked course evidence guide. The objective map distinguishes tested decisions from concepts taught in explanations.

Concepts: glom-04, glom-07, glom-08, glom-09, glom-18, glom-19, glom-22, glom-23, glom-24, glom-25, htn-cardiorenal-17.

Case 25: The Puffy Second-Grader · 7 short lessons

Open the staged case →

Approach → findings → interpretation → treatment

Recognize the nephritic pattern using pediatric BP and creatinine context. Interpret infection/complement findings and follow the recovery trajectory.

2 · Findings

Build the pattern as the history, examination and results arrive.

Open this stage →

3 · Lab interpretation

Use the mechanism to explain the blood, urine or imaging findings.

Open this stage →

4 · Treatment and reassessment

Connect the treatment with the response, risks and follow-up.

Open this stage →

Review the shared urgent-threat framework →

Opening visual framework

Different barrier injuries produce different urine clues. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Lab interpretation guide

· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Treatment and reassessment guide

Interpret BP within the child’s reference framework. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Learn first · decision primers

Explain the whole case

Which pediatric findings change urgency, and which recovery findings would make you reconsider the diagnosis?

All relevant lecture connections

Return to the lecture topics

Assigned reading: the explanations in this case and the question-linked course evidence guide. The objective map distinguishes tested decisions from concepts taught in explanations.

Concepts: aki-01, aki-02, aki-24, glom-07, glom-12, glom-13, glom-17, glom-23, htn-cardiorenal-17, lytes-13.

Case 26: The Sports Physical · 7 short lessons

Open the staged case →

Approach → findings → interpretation → treatment

Repeat and quantify the urine findings, keeping protein and blood as separate questions. Family history and urologic risk can point toward different investigations.

2 · Findings

Build the pattern as the history, examination and results arrive.

Open this stage →

3 · Lab interpretation

Use the mechanism to explain the blood, urine or imaging findings.

Open this stage →

4 · Treatment and reassessment

Connect the treatment with the response, risks and follow-up.

Open this stage →

Review the shared urgent-threat framework →

Opening visual framework

A screening pad points to a next question. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Lab interpretation guide

Urine particles can help localize injury. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Treatment and reassessment guide

A test result needs phenotype and interpretation. See the diagram description and full text below.
· Download image · Download Markdown · Read text and evidence

Use the visual framework with the case findings and the linked lecture.

Learn first · decision primers

Explain the whole case

Why can reassuring orthostatic proteinuria coexist with important hematuria or inherited disease?

All relevant lecture connections

Return to the lecture topics

Assigned reading: the explanations in this case and the question-linked course evidence guide. The objective map distinguishes tested decisions from concepts taught in explanations.

Concepts: glom-01, glom-03, glom-05, glom-06, glom-26, htn-cardiorenal-17, structural-11.