Nephrology · Model history
Cola-colored urine and facial swelling: a model nephrology history
- Setting
- Outpatient clinic
- Patient
- Ms. Brown, 22, noticed dark, cola-colored urine and facial swelling two weeks after an untreated sore throat.
- Listen
- 4 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“Yes, actually, I had a really bad sore throat with a fever about two weeks ago. I never went to the doctor for it, and it eventually went away on its own.”
Ask about swelling in the legs or ankles and any shortness of breath.
Any swelling in your legs or ankles, or shortness of breath?
Model interview
Full transcript
- Doctor
Ms. Brown, I'm Dr. Osei. What's going on today?
- Patient
This morning my urine came out dark, almost like cola, and my face looks puffy around my eyes. It's really scared me.
- Doctor
When exactly did you first notice the dark urine?
- Patient
Just this morning, when I went to the bathroom. I've never seen it that color before.
- Doctor
Has the color changed at all since then, or stayed the same?
- Patient
It's stayed about the same, dark brown, like tea or cola.
- Doctor
Tell me about the puffiness around your eyes. When did that start, and is it worse at any particular time?
- Patient
I noticed it this morning too, and it does look worse right when I wake up.
- Doctor
Have you had any headache or noticed anything about your blood pressure?
- Patient
I've had a mild headache today, but I haven't checked my blood pressure.
- Doctor
Has the amount of urine you're passing changed? More, less, or about the same?
- Patient
I think it's a bit less than usual, now that you mention it.
- Doctor
Do you have any pain when you urinate, or pain in your back or side?
- Patient
No burning, and no back pain.
- Doctor
Have you been sick recently? A sore throat, fever, or skin infection?
- Patient
Yes, actually, I had a really bad sore throat with a fever about two weeks ago. I never went to the doctor for it, and it eventually went away on its own.
- Doctor
Any swelling in your legs or ankles, or shortness of breath?
- Patient
My ankles look a little swollen too, now that I think about it. No trouble breathing.
- Doctor
Any joint pain, rash, or blood in your stool?
- Patient
No, none of that.
- Doctor
Do you have any other medical conditions, or take any regular medicines?
- Patient
No, I'm generally healthy and don't take anything regularly.
- Doctor
Any medicine allergies?
- Patient
No, none that I know of.
- Doctor
What do you think is going on?
- Patient
I thought maybe I have a bad urinary tract infection and I'm bleeding internally.
- Doctor
What's worrying you most?
- Patient
The dark urine and my face swelling up really scared me. It doesn't feel normal at all.
- Doctor
What were you hoping we'd do today?
- Patient
I was hoping you could give me antibiotics to clear up the kidney infection.
- Doctor
Let me make sure I have this right. This morning you noticed dark, cola-colored urine along with puffiness around your eyes that's worse on waking, a mild headache, slightly reduced urine output, and some ankle swelling. About two weeks ago you had an untreated sore throat with fever. You have no burning with urination, back pain, joint pain, or rash. Is that accurate, and is there anything else?
- Patient
That's exactly right, nothing else.
- Doctor
Thank you. This isn't a bladder infection. The pattern of dark urine, facial swelling, and a sore throat about two weeks earlier points to your kidneys' filters reacting to that infection, called post-streptococcal glomerulonephritis. We'll check your blood pressure, kidney function, and urine under the microscope right away, and treat the swelling and blood pressure while your kidneys recover over the next several weeks.
- Patient
Okay, that's a relief to understand what's actually happening.
Flow at a glance
The route through the history
- Invite the patient's description
- Establish the timing and color of the dark urine
- Characterize the facial swelling pattern
- Screen kidney-related symptoms and urine output
- Rule out a simple urinary infection
- Ask about a recent throat or skin infection
- Review background, medicines, and allergies
- Summarize and explain the real diagnosis
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
Editorial update: