A 35-year-old man with a history of chronic hepatitis C infection presents with bilateral foot drop. He contracted hepatitis C perinatally.
On examination, there is bilateral weakness of ankle dorsiflexion and a purple, painful, non-blanching rash seen in both feet and the fingers of the left hand.
His urine dipstick reveals 2+ protein, 3+ blood, and 1+ leukocytes. What is the most likely histological appearance on renal biopsy?
MRCP2-4012
A 67-year-old man with a history of chronic renal failure due to diabetes presents to the clinic with complaints of increasing bone and muscle aches. He is currently taking ramipril, amlodipine, and indapamide for blood pressure control, atorvastatin for lipid management, and insulin for blood sugar control. On examination, his blood pressure is 148/80 mmHg, pulse is 79 and regular, and BMI is 28.
Investigations reveal a haemoglobin level of 107 g/L (135-177), white cell count of 8.2 ×109/L (4-11), platelets of 202 ×109/L (150-400), serum sodium of 140 mmol/L (135-146), serum potassium of 5.0 mmol/L (3.5-5), creatinine of 192 µmol/L (79-118), and calcium of 2.18 mmol/L (2.2-2.67). His phosphate level is elevated at 1.9 mmol/L (0.7-1.5) despite following a low phosphate diet.
What would be the most appropriate next step in controlling his phosphate levels?
MRCP2-4001
A 33 year-old man came to his GP complaining of dark coloured urine. He had a sore throat two weeks ago but didn’t seek medical attention. He had no significant medical or family history.
During the examination, his pulse was recorded at 60 beats per minute and his blood pressure was 160/95 mmHg. There were no notable findings during abdominal examination. Urinalysis revealed 3+ blood and 1+ protein.
What is the primary diagnostic test that needs to be conducted?
MRCP2-4011
A 75-year-old man, who has been diagnosed with multiple myeloma, is currently being investigated for a decline in his renal function. His laboratory results from a year ago and today are as follows:
To determine if the decline in renal function is associated with a complication of his myeloma, what stain should be performed during his renal biopsy?
MRCP2-4005
A 54-year-old man presented with acute dyspnoea.
His past medical history includes three vessel coronary artery bypass surgery for ischaemic heart disease and hypertension. Examination revealed widespread expiratory crackles with chest x ray confirming pulmonary oedema. He was treated with intravenous nitrates and furosemide with symptomatic improvement.
Which of the following is most likely to have caused the deterioration in renal function?
MRCP2-4006
A 65-year-old man presents with hypertension at 170/95 mmHg and deteriorating kidney function. He has a history of a previous transient ischemic attack and is a heavy smoker, consuming 20 cigarettes per day. Imaging studies reveal stenosis of the right renal artery. Can you estimate the five-year survival rate for patients with this condition?
MRCP2-4002
A 65-year-old man, with chronic renal disease and on peritoneal dialysis, presents to his local renal unit after hours with complaints of abdominal pain and nausea. He reports having cloudy bags during his peritoneal dialysis at home for the past 12 hours, which is a new experience for him. Upon examination, he appears to be in good health, with a temperature of 37.8°C, a pulse rate of 80, and a blood pressure of 130/80 mmHg. His abdomen is soft to the touch, with no signs of guarding or rebound, and there is no redness around the exit site of the peritoneal dialysis catheter. The patient mentions having a penicillin allergy since childhood. The renal nurse has already sent PD fluid for microscopy and culture after draining the fluid. What is the most appropriate course of action?
MRCP2-4013
A patient in their 60s with stage 5 chronic kidney disease (CKD) visits the outpatient clinic to explore the option of a renal transplant.
Which of the following is not a commonly known adverse effect of ciclosporin?
MRCP2-4016
A 50-year-old male of African–Caribbean descent presented to the emergency department complaining of leg swelling, shortness of breath, and nausea that had been progressively worsening over the past 6 weeks. He had recently relocated to the UK from South Africa about 3 months ago. The patient had a history of mild peripheral vascular disease and was taking atorvastatin and clopidogrel.
Upon examination, the patient was comfortable at rest but had significant pitting edema in both lower limbs and bilateral dullness to percussion at the lung bases. His blood pressure was 181/101 mmHg.
The urine dipstick showed 2+ blood and 4+ protein. Blood test results revealed a urea level of 21 mmol/L (2.0 – 7.0), creatinine level of 256 µmol/L (55 – 120), and albumin level of 24 g/L (35 – 50). The 24-hour urine protein measurement was 8g/day.
Further blood tests were conducted, including ANA, ANCA, complement (C3 and C4), hepatitis serology, HIV screening serology, and serum protein electrophoresis, which all came back negative. A renal ultrasound was performed, which showed an increased echogenicity bilaterally but no hydronephrosis. Peak flow velocities were normal and equal bilaterally. A renal biopsy was also performed, revealing segmental areas of scarring affecting some of the glomeruli, with no hypercellularity or crescents visible.
What is the appropriate management plan for this patient, given the likely diagnosis?
MRCP2-4004
A 60-year-old woman with end-stage renal disease received a renal transplant six months ago. Her baseline creatinine is 130 µmol/L. During physical examination, her blood pressure is 170/80 mmHg and she experiences discomfort in her transplant kidney area. Her blood test results show urea 25 mmol/l, creatinine 550 µmol/l. What is the most probable renal pathology to reoccur in a patient who has undergone a renal transplant?