Mark is a 58 year old male who presents to his GP due to a recent but on-going, dull ache in his lower back,on the left. Mark has a history of post-infection glomerulonephritis, which was treated...

Mark is a 58 year old male who presents to his GP due to a recent but on-going, dull ache in his lower back,on the left. Mark has a history of post-infection glomerulonephritis, which was treated successfully at thetime, but he wonders if it has come back.Mark’s past medical history includes:•10 years ago, post-streptococcal glomerulonephritis•Osteoarthritis Left knee•Mild Rheumatoid Arthritis both hands•Peptic Ulcer, recent diagnosis (can’t remember specifically when)•Recurrent Depression, treated non-pharmacologically with CBT and ACT•No recollection of recent injury to his backMark’s current medications includes:•Mycophenolate Mofetil 1500 mg, twice daily•Misoprostol (Cytotec) 400 µg, twice daily •Paracetamol (Osteomol) eight hourly (two tablets)Mark’s family history includes:•He was adopted and no family history is available•Two daughters, both apparently healthy Mark’s social history includes: •Married•Reformed heavy smoker•No illicit drug use•Normal, average diet•Left knee pain limits his activity•Recent spike in back pain has stopped any physical activity Physical Examination:•58 yo, Caucasian male, alert but obviously in significant discomfort•Height 6’ 2” (188 cm)•Weight 100 kg•Blood Pressure 125/73 •Heart Rate 65 bpm•Respiration Rate 17 per minute•Temperature 37oC •Murphy’s percussion test (Murphy’s punch sign; costovertebral angle tenderness [CVAT]) positive (significant)•Significant bilateral supraclavicular lymphadenopathy 91530 PP2 DocumentPage6 of12•Abdomen is soft, with a tender, palpable mass in the Left flank region Test Results: •UrineoWhite Blood Cells - higher than the normal reference range (high power field examination)oRed Blood Cells – too numerous to count •Abdominal CT scan:oWell-defined, single, irregular, solid nodule, approx. 8 cm diameter, superiorpole of the Left kidneyoSigns of invasion into surrounding adipose tissue•Chest X-ray:oLeft lung: three, individual, solid lesions, each approx. 2- 2.5 cm in diameter