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Edward's referral

Back to Case study – Edward

PMR can mimic many other conditions. Edward had symptoms which met the core inclusion criteria for PMR, but the following features should lead you to reconsider the diagnosis:

  • his moderate response to steroids
  • the presence of haematuria
  • poorly controlled blood pressure renal impairment.

Given the deterioration in renal function, continued elevation in ESR and blood found on urine dipstick you decide to organise an urgent ultrasound scan. The scan reports:

"A large homogeneous solid mass with well-defined margins is visualised inferior to the liver. A normal right kidney is not identified."

These findings are most consistent with a renal tumour. You refer him to the urology suspected cancer clinic where he's diagnosed with a renal cell carcinoma and is started on treatment.

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