Station 77

Damian Brookes

Age: 20 year old male

Full Case

Station List
Doctor
Patient
Examiner

Patient’s Data​

Patient’s Name: Damian Brookes

Age: 20-year-old male

Past Medical History:

  • None recorded

Drug and Allergy History:

  • Not currently on any medication
  • No know drug allergy 

 

Recent Notes/Consultation

 

Out-of-Hours Summary Letter

RE: Damian Brookes |20 years old | Male

Damian was seen yesterday at the out-of-hours service, reporting visible blood in his urine over the past two days. He denied any associated symptoms such as pain, dysuria, urinary frequency, or systemic symptoms. He is not sexually active.

On examination, he was haemodynamically stable. A urine dipstick test was performed, which showed 1+ haematuria and 1+ protein. Nitrites and leucocytes were negative.

The patient was advised to follow up with his GP for further assessment and investigation if symptoms do not settle.

Seen By: 

Angela Carter, Advanced Nurse Practitioner (RN, MSc Advanced Clinical Practice, Independent Prescriber)




Patient booked a routine video appointment to discuss concerns

Patient's Story (Role player’s brief)

Patient’s Story 

Opening Statement: “Hi doctor, I’ve noticed some blood in my urine for the past few days, and I’m really worried about what it could mean.”

You are Damian, a 25-year-old man who has noticed visible blood in your urine over the last three days. You have had no pain, burning, or other urinary symptoms. You are not sexually active and do not believe you are at risk of sexually transmitted infections.

Only say the following if asked:
You had a sore throat about two weeks ago, but it resolved completely on its own. You went to a walk-in centre yesterday where they tested your urine and found both blood and protein. They advised you to follow up with your GP, which is why you have booked this appointment.

Social History: You do not smoke, drink alcohol, or use recreational drugs. You work as a builder.

Ideas: You are unsure what might be causing the blood.

Concerns: You were not initially worried, but your mum mentioned it could be something serious like cancer, which has made you anxious.

Expectations: You want the GP to explain what is causing the blood in your urine and to advise you on what happens next.

Say NO to any other questions asked outside of the details already provided in the scenario. Accept anything offered to you by the doctor.  

Marking Scheme

Data Gathering and Diagnosis

  • Ask about onset of symptoms
  • Ask if the blood in the urine appears bright red, pink, or dark/tea-coloured
  • Ask if there is any pain on urination/dysuria
  • Ask about frequency and other lower urinary tract symptoms (LUTS)
  • Ask about other relevant associated symptoms such as fever, nausea or vomiting
  • Ask about abdominal, loin, or back pain (to help rule out renal stones)
  • Ask about any previous episodes of blood in the urine
  • Ask about recent flu-like symptoms or sore throat 
  • Ask about swelling around the eyes (periorbital oedema—suggestive of glomerulonephritis)
  • Ask about sexual history and any penile discharge (to rule out STI-related urethritis)
  • Ask about smoking, alcohol use, and occupation
  • Ask about family history of kidney disease
  • Ask about red flag cancer symptoms—weight loss, night sweats, loss of appetite
  • Explore patient’s ideas, concerns, and expectations (ICE)
  • Give a likely diagnosis of post-streptococcal glomerulonephritis

Example of explanation to patient​

Thanks for speaking with me today, Damian. I understand it’s been quite worrying to notice blood in your urine, especially when someone close to you, like your mum, suggests it might be something serious like cancer.

From what you’ve described, and based on your age and lack of other symptoms, cancer is extremely unlikely. That said, blood in the urine is never something we ignore, so it’s absolutely right that you’ve come to discuss it.

Now, there are a few possible reasons why someone might pass blood in their urine. In your case, the fact that you recently had a sore throat and your urine also showed protein when it was checked could point to something called post-streptococcal glomerulonephritis. That’s a condition where the kidneys become temporarily inflamed after a throat infection. It’s not usually serious and often gets better on its own, but we do need to investigate further to confirm the diagnosis and rule out anything else.

I would like to see you face to face today so I can check your blood pressure, examine your abdomen, and arrange some tests. These will include blood tests to check how your kidneys are functioning and whether your body has reacted to a recent infection. We’ll also send another urine sample for more detailed analysis, including checking for any protein leakage from your kidneys. Are you happy to come in for all of this today?

I would also recommend we do a jelly scan of your kidneys called ultrasound scan. This is just to make sure there’s nothing, like a blockage or stone that is causing your symptoms. 

We’ll keep an eye on things by checking in with you every 1 to 2 weeks to make sure the blood in the urine settles. If anything looks unusual or if it doesn’t improve, we’ll refer you to a kidney specialist. 

And just to be on the safe side, if you notice any new or worsening symptoms, like swelling in your ankles, face or hands, or if you feel breathless, I’d want you to get in touch immediately.

Does all of that make sense? 

Management

Management

  • Offer a face-to-face appointment for clinical assessment, including blood pressure measurement and repeat urinalysis
  • Offer to send urine for culture and urine albumin: creatinine ratio (ACR)
  • Arrange blood tests: full blood count (FBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), urea and electrolytes (U+Es), and antistreptolysin O titre (ASOT)
  • If the sore throat is still present, send a throat swab to check for Group A Streptococcus
  • Offer a renal ultrasound scan to assess kidney structure
  • Advise that his haematuria will be monitored every 1–2 weeks to ensure resolution; referral to nephrology will be considered if haematuria persists or any abnormal findings arise from investigation results. 
  • Provide safety netting: advise Damian to seek urgent medical attention if he develops worsening symptoms such as facial, hand, or ankle swelling, shortness of breath, or any other concerning changes
  • Arrange follow-up in 1–2 weeks to review test results and monitor progress

Learning point from this station: ​

Post-streptococcal glomerulonephritis (PSGN) should be considered in any patient presenting with painless visible haematuria, particularly if there is a recent history of streptococcal infection. PSGN characteristically occurs 7 to 14 days after a Group A beta-haemolytic streptococcal throat infection, or up to 6 weeks following a skin infection such as impetigo. It is more common in children. 

PSGN is usually a self-limiting condition, and in most cases, only symptomatic management and monitoring are needed. However, it is important to perform appropriate investigations (urinalysis, renal function, ASO titre, and imaging where needed) to confirm the diagnosis, rule out other causes, and ensure there is no progression to significant renal impairment.

Further reading