A 20-year-old woman presents with increasing breathlessness and hypoxia two days after being admitted for severe burns. She has no significant medical history, but her father had a heart attack at age 40. She is a non-smoker and has a respiratory rate of 26 breaths per minute and a pulse rate of 110 beats per minute. Crackles are heard over both lung fields on examination, and a chest x-ray shows bilateral hazy shadowing. What is the probable diagnosis?
A 30-year-old man presents with vomiting, confusion, general malaise and abdominal pain. His initial blood tests reveal low hemoglobin, low platelets, high white blood cells, and elevated levels of urea, creatinine, and LDH. The ESR is also high, and the PT and APTT are within normal limits. After ruling out Shiga toxin and ADAMS-13, the patient is diagnosed with atypical hemolytic-uremic syndrome and undergoes plasma exchange. What other treatment has been proven effective in managing this condition?
A 26-year-old man presents to the Nephrology clinic for review. He was recently diagnosed with IgA nephropathy after experiencing multiple episodes of haematuria. He has a medical history of coeliac disease but is otherwise healthy and not taking any medications. During the review, his blood pressure is measured at 122/84 mmHg. The latest investigation results are as follows:
– Na+ 138 mmol/L (135 – 145)
– K+ 3.9 mmol/L (3.5 – 5.0)
– Bicarbonate 26 mmol/L (22 – 29)
– Urea 5.1 mmol/L (2.0 – 7.0)
– Creatinine 88 µmol/L (55 – 120)
Additionally, a 24-hour urine protein collection shows 1300mg (<150). What is the most appropriate management option?
A 23-year-old woman presents to the clinic with elevated blood pressure of 148/86 mmHg. She has had no significant medical history in the past.
Upon examination, her chest and abdominal examination are unremarkable except for the high blood pressure. You suspect that there may be an underlying serious condition and order a series of tests.
The results of the investigations are as follows:
Test Result Normal Range
Hemoglobin (Hb) 130 g/l 135–175 g/l
White blood cell count (WBC) 4.8 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 190 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 3.2 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 98 μmol/l 50–120 µmol/l
Bicarbonate (HCO3-) 34 mmol/l 24–30 mmol/l
Aldosterone erect 180 pmol/l 200-1000 pmol/l
Renin erect 3.0 pmol/ml/hr 2.8-4.5 pmol/ml/hr
What is the most probable diagnosis?
A 65-year-old man with a renal transplant presents to the clinic. He has noticed increased swelling in his legs over the past 3 weeks but is otherwise feeling well.
During the examination, his blood pressure is found to be 160/100 mmHg and he has pitting edema up to the mid-calf bilaterally. A urine dip test shows 3+ protein and 2+ blood, and his serum creatinine level has risen from 80 umol/l to 140 umol/l.
After a renal biopsy, it is discovered that his original disease has recurred.
Which disease has the highest recurrence rate in patients who have undergone renal transplantation?
A 72-year-old male presents to the renal outpatient clinic with a gradual decline in renal function over the past 4 years. His creatinine level has risen to 482 µmol/l and his estimated glomerular filtration rate is at 7 ml/min. He has also noticed a decrease in urine output over the past 3 months. The patient has a medical history of hypertension, type 2 diabetes mellitus, and a laparotomy for a duodenal ulcer 35 years ago. He also has an unrepaired incisional hernia. During the consultation, renal replacement therapies are discussed with the patient. He expresses a strong desire for the least restrictive option, but acknowledges that his health is the top priority. A recent ultrasound revealed bilateral atrophic kidneys with extensive bilateral iliac vessel calcification. What is the most appropriate next step in treatment?
A 65-year-old man presents with anuria and lower back pain that has been ongoing for 24 hours. He is currently taking bendroflumethiazide 2.5 mg for hypertension and is otherwise healthy, although he is awaiting an appointment for urinary frequency, urgency, and dribbling. Upon investigation, his potassium levels are found to be elevated at 6.5 mmol/l. After administering iv insulin and dextrose, his potassium levels have decreased to 5.4 mmol/l, and he has been catheterized. What is the most appropriate next step in management?
A 72-year-old dialysis-dependent woman is brought to the emergency department with complaints of difficulty breathing. Her husband reports that she had chest pains the previous night before going to bed.
Upon examination, her respiratory rate is 28, her JVP is elevated, and coarse crepitations are heard throughout both lung fields. Urgent U&Es show:
– Serum sodium 138 mmol/L (135-146)
– Serum potassium 4.2 mmol/L (3.5-5.0)
– Chloride 109 mEq/L (97-107)
– Urea 23.8 mg/dL (10-20)
– Creatinine 812 μmol/L (79-118)
The patient reports not passing any urine, making it impossible to provide a specimen for urinalysis. An ECG shows sinus rhythm and anterolateral ischaemic changes, while a chest x-ray reveals marked interstitial oedema in both lungs.
What is the most appropriate management to address the patient’s shortness of breath?
A 25-year-old woman presents to your clinic, referred by her yoga instructor. She is typically in good health and is currently in the midst of a 4-week yoga teacher training program. She has noticed dark urine for the past few days and is concerned that she may have a serious condition. She describes the urine as the color of iced tea. She denies having a fever and has no other complaints or discomfort aside from the dark urine.
The patient appears to be in good physical condition and is not in any obvious distress. Her vital signs are within normal limits, with a temperature of 37.0 °C, blood pressure of 110/70 mmHg, and a pulse of 70 bpm. Her extremities are non-tender and non-edematous, and the rest of her physical exam is unremarkable.
The following laboratory results are obtained:
– Creatinine (Cr): 180 µmol/l (normal range: 50 – 120 µmol/l)
– Urea: 12.0 mmol/l (normal range: 2.5 – 6.5 mmol/l)
– Hemoglobin (Hb): 130 g/l (normal range: 135 – 175 g/l)
– Potassium (K+): 4.2 mmol/l (normal range: 3.5 – 5.0 mmol/l)
– White cell count (WCC): 8 × 109/l (normal range: 4.0 – 11.0 × 109/l)
What would be the most appropriate initial test to perform for further evaluation?
A 67-year-old man with IgA nephropathy is being seen in the renal dialysis clinic for the first time. He is nearing stage 4 kidney disease and his doctor is preparing him for dialysis soon. Due to past abdominal surgeries, peritoneal dialysis is not an option. What is the preferred initial choice for vascular access for routine haemodialysis?