These teaching cases are drawn from real clinical encounters, de-identified and structured for progressive disclosure learning. Each case integrates multiple organ systems and demands the kind of clinical reasoning that separates competent from exceptional clinicians. They are designed for medical students, PA students, internal medicine residents, and practicing physicians who want to sharpen their diagnostic thinking.
Available Cases
A patient with positive blood cultures, a homogeneous ANA at 1:320, severe complement consumption, and acute glomerulonephritis. Is this systemic lupus erythematosus with lupus nephritis, or infective endocarditis with infection-associated glomerulonephritis? The overlapping immunologic features, asymmetric risk of misdiagnosis, and systematic approach to distinguishing these entities make this case a masterclass in diagnostic reasoning under uncertainty.
An 84-year-old woman with decompensated heart failure, nephrotic-range proteinuria, and an EF of 45% that produces a cardiac index of 1.75 -- near-cardiogenic shock range. This case systematically teaches right heart catheterization interpretation, echocardiographic diastolic assessment, urine protein dissection (ACR vs. PCR), free light chain interpretation in CKD, and the integrative reasoning that connects cardiac, renal, and hematologic findings into a single unifying diagnosis.
A 75-year-old man with refractory ascites, CT showing "cirrhosis," and an EF of 55%. Right heart catheterization reveals cardiogenic shock-range hemodynamics invisible to echocardiography: cardiac index 1.15, RA pressure 23, PCWP 28, PVR 4.8 Wood units. Four converging diagnostic traps -- preserved EF, cardiac pseudo-cirrhosis, absence of nephrotic syndrome, and dismissed FLC values in CKD -- delayed recognition of fatal lambda cardiotrophic AL amyloidosis. The patient died before therapy could be initiated.
Clinical Mastery Series • Urine Nephrology Now Home
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