A 60-year-old man presents with a three week history of penile swelling. He has a medical history of obesity, asthma, and a previous diagnosis of colorectal cancer. Upon examination, he displays global pitting edema and a mild expiratory wheeze. The admission blood tests reveal:
– Sodium (Na+): 142 mmol/l
– Potassium (K+): 3.6 mmol/l
– Urea: 6.9 mmol/l (baseline 4.2 mmol/l)
– Creatinine: 126 µmol/l (baseline 84 µmol/l)
What is the most likely diagnosis?
A 28-year-old female presents to the clinic with complaints of abdominal discomfort. She has been experiencing vague lower abdominal pain intermittently for several months. Although her weight has been stable, she occasionally loses her appetite. She is married and takes the combined oral contraceptive as her only medication. On examination, she appears well with a BMI of 24.5 kg/m2 and a blood pressure of 140/80 mmHg. No abnormalities are noted on chest, heart, or abdominal examination, and her neurology and fundoscopic examination are normal. Laboratory investigations reveal a serum urea level of 5.9 mmol/L (2.5-7.5) and a serum creatinine level of 90 µmol/L (60-110). Her urine dipstick shows the presence of blood and protein. An ultrasound scan of the abdomen reveals a small right kidney. What is the most likely cause of this patient’s presentation?
A 20-year-old female presents with significant oedema and frothy urine. Upon investigation, she is found to have an albumin level of 10 and heavy proteinuria of 11.5 g/l, along with a cholesterol level of 9. A renal biopsy confirms a diagnosis of minimal change nephropathy, and she initially responds well to oral prednisolone. However, upon withdrawal of steroids, she quickly relapses.
The patient is readmitted with a painful left leg and worsening oedema. Doppler ultrasonography reveals a deep vein thrombosis extending to her external iliac vein, and she is started on heparin. Despite treatment, her symptoms do not improve. She is put back on oral prednisolone and diuretics, but her albumin level remains at 20.
On examination, the patient has significant oedema in both legs and mild facial swelling. Her left leg is painful and has a dusky hue. Her JVP is not raised, and her blood pressure is 110/70 mmHg while lying down and 102/62 mmHg while standing.
Further investigations show an APTT ratio of 1.86 and an INR of 1.5. What is the most likely diagnosis?
A 38 year-old female patient presents with a four month history of abdominal distension, facial swelling and malaise. She has a past medical history of membranous glomerulonephritis. On examination, heart sounds 1 and 2 were present with no added sounds and the pulse was regular. Lung fields were clear, and abdominal exam reveals mild ascites. There was bilateral periorbital oedema with pitting oedema of the shins.
Blood tests reveal:
– Hb 8.8 g/dL
– Platelets 115 * 109/l
– WBC 4.2 * 109/l
– Mean corpuscular volume (MCV) 82 fl
– Na+ 148 mmol/l
– K+ 3.3 mmol/l
– Urea 9.2 mmol/l
– Creatinine 176 µmol/l
– Bilirubin 14 µmol/l
– ALP 91 u/l
– ALT 19 u/l
– γGT 68 u/l
– Albumin 32 g/l
– Cholesterol 7.9 mmol/l
Urinalysis reveals protein +++ and a 24-hour protein excretion is 5.2g.
The patient was started on high-dose diuretics and immunosuppression. Two weeks later, she presents with abdominal pain which is 6/10 on the pain scale and worse in her flanks. Her observations were normal apart from a temperature of 38.3ºC. Blood tests are performed and are similar to before except a raised creatinine to 314 µmol/l and a urea of 15.1 mmol/l.
What is the most likely reason for this patient’s deterioration in renal function?
A 30-year-old man presents to your acute medical unit with right flank pain that has been constant for the past 2 weeks. Despite taking paracetamol tablets, the pain has not subsided. He denies experiencing dysuria and is generally in good health, although he is a smoker. He mentions that his sister recently passed away from a subarachnoid haemorrhage caused by a berry aneurysm.
Upon examination, the patient’s heart rate is elevated at 110 bpm, but all other observations are normal. A urine dipstick test reveals 2+ blood and nothing else. Blood tests show a sodium level of 141 mmol/l, potassium level of 4.6 mmol/l, urea level of 3.6 mmol/l, creatinine level of 84 mol/l, and CRP level of 34 mg/l. His FBC is normal.
What is the most likely diagnosis?
A 75-year-old man presents with significant peripheral swelling and fatigue. Upon further inquiry, it is discovered that he has been experiencing difficulty swallowing and a subsequent CT scan reveals the presence of oesophageal cancer. Despite initial treatment with furosemide and prednisolone, his kidney function continues to decline. The following are his blood test results:
– Sodium: 132 mmol/l
– Potassium: 5.6 mmol/l
– Bicarbonate: 17 mmol/l
– Urea: 27.5 mmol/l
– Creatinine: 352 µmol/l
– Albumin: 19 g/L
He consents to a renal biopsy. What is the expected outcome of the biopsy?
A 47-year-old man with type 2 diabetes mellitus attends a routine diabetes clinic review and is diagnosed with low sodium. Which medication is the most probable cause?
A 76-year-old Afro-Caribbean woman is worried about the health of her kidneys and requests screening for chronic kidney disease. As per the guidelines of the National Institute for Health and Care Excellence (NICE) on the detection and treatment of chronic kidney disease, which of the following factors is a risk factor and warrants screening for chronic kidney disease?
A 55-year-old woman, originally from Thailand, presents with a 4 week history of haemoptysis, a dry irritating cough and progressive shortness of breath that has reduced her ability to climb stairs and walk distances greater than roughly 50 meters. She has no other medical history of note apart from an appendectomy when younger. She takes no regular medication except for over the counter herbal remedies that she gets from a local Chinese medicine shop, although she cannot remember what these are called. She smokes 10 cigarettes per day and does not drink alcohol.
Examination reveals heart sounds 1 and 2 present with no added sounds. Some crackles across the chest. Observations are normal.
Blood tests reveal:
Hb 99 g/l
MCV 74 fL
Platelets 196 * 109/l
WBC 14.8 * 109/l
Na+ 133 mmol/l
K+ 5.0 mmol/l
Urea 15 mmol/l
Creatinine 193 µmol/l
ESR 92 mm/hr
A chest x-ray is performed which reveals some diffuse alveolar infiltrates but no focal areas of consolidation. A sputum sample is analysed for MC and S and shows no malignant cells.
What is the most likely diagnosis?
A 54-year-old female with progressive proteinuric diabetic nephropathy presents at the renal low clearance clinic. Despite receiving maximal medical therapy, her poorly controlled type 1 diabetes since the age of 20, hypertension, and hypercholesterolemia have led to a deterioration in her kidney function. Although she feels fit and well, she is worried about her condition. Physical examinations reveal a sensory peripheral neuropathy, reduced dorsalis pedis pulses bilaterally, and pitting edema in both ankles. Fundoscopy shows evidence of photocoagulation therapy in both eyes. Blood tests reveal a Hb of 109 g/l, platelets of 111 * 109/l, WBC of 5.7 * 109/l, Neuts of 4.6 * 109/l, HbA1c of 86 mmol/mol, and an eGFR of 18 ml/min/1.732. Her eGFR was 20 three months ago. Given her progressive stage 4 chronic kidney disease, what is the most effective treatment option available?