Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of [chronic/subacute] flank or lower back pain, accompanied by [weight loss/fatigue/fever]. Review of systems is significant for [urinary frequency/hesitancy/anuria]. History notable for [known autoimmune disease/IgG4-related disease/recent medication use]. Symptoms are progressive, raising concern for ureteral obstruction and renal impairment.
Clinical Examination Findings
General: Patient appears [well-developed/ill-appearing/distressed]. Vitals: [BP/HR/Temp]. Abdomen: Soft, non-tender, though deep palpation may reveal a vague, non-pulsatile midline mass. Extremities: [Presence/absence] of lower extremity edema. Skin: No evidence of rashes or vasculitic lesions.
Treatment Protocol
Plan: 1. Initiate corticosteroid therapy (e.g., Prednisone [dose] mg/day) to induce remission. 2. Urological consultation for ureteral stenting or nephrostomy if obstructive uropathy is present. 3. Consider immunosuppressive agents (e.g., Mycophenolate Mofetil/Tamoxifen) for refractory cases. 4. Monitor renal function (Cr/GFR) and inflammatory markers (ESR/CRP) serially.