A 70-year-old man undergoes a laparotomy to correct a small bowel obstruction. He has a medical history of orthotopic bladder reconstruction due to bladder carcinoma. After 48 hours in the High Dependency Unit, he becomes confused and refuses to consume oral fluids. His vital signs are stable, but his serum biochemistry and blood gas analysis reveal abnormalities. What is the most suitable initial intervention?
A 28-year-old woman with type 1 diabetes is admitted to the hospital due to diabetic ketoacidosis. She has a history of three retinal photocoagulation episodes for diabetic retinopathy. After receiving adequate fluid resuscitation, she makes a good recovery. Her blood tests reveal mild renal impairment with a creatinine level of 99 μmol/L (eGFR 60 ml/min/1.73m2), and her blood pressure is 116/43 mmHg. She is currently taking Lantus and NovoRapid insulins as her only medications. A renal ultrasound shows no abnormalities, and a random urine sample is sent to the laboratory for analysis. The microscopy results are unremarkable, and the urinary albumin:creatinine ratio (ACR) is reported as 17 mg/mmol (<2.5). What is the most appropriate action to take?
You have been requested to examine a patient with the following blood results:
Sodium 141 mmol/L (137-144)
Potassium 4.2 mmol/L (3.5-4.9)
Creatinine 79 μmol/L (60-110)
cANCA positive
anti-PR3 4
anti-MPO >100
What is the probable diagnosis for this patient?
A 19 year-old man presented to his physician complaining of facial puffiness and leg swelling that had developed over the past few weeks. He had no significant medical history and no family history of note. He was not taking any regular medications.
During the physical examination, his pulse was found to be 90 beats per minute and his blood pressure was 140/80 mmHg. Cardiovascular, respiratory and abdominal examination did not reveal any abnormalities. Urinalysis showed 4+ protein and 1+ blood, but was negative for glucose.
The following laboratory results were obtained:
– Hemoglobin: 138 g/l
– Platelets: 185 * 109/l
– White blood cells: 6.6 * 109/l
– Sodium: 144 mmol/l
– Potassium: 4.0 mmol/l
– Urea: 5.5 mmol/l
– Creatinine: 78 µmol/l
– Serum albumin: 20 g/L
– 24 hour urine protein: 5.1 g (<0.2)
A renal biopsy was performed and showed podocyte fusion on electron microscopy.
What is the most appropriate next step in the treatment of this patient?
A 67-year-old woman presents to the hospital with transient dysphasia and left-sided weakness affecting her face and arm. She has a medical history of ischaemic heart disease, hypertension, and end-stage renal failure, and undergoes haemodialysis every Monday, Wednesday, and Friday mornings. A plain CT scan of the brain shows no evidence of an acute infarction or haemorrhage. Further brain imaging is requested by the consultant, and you are asked to coordinate with the radiology department. What statement applies to this patient?
A 15-year-old female patient is referred to the hospital by her GP due to ankle and facial swelling, as well as dark urine that has been present for four days. She had visited the practice two weeks ago with pharyngitis. During examination, her blood pressure is found to be 165/100 mmHg, and her urine dipstick shows a strong positive for protein and blood.
Upon admission, the patient is diagnosed with acute kidney injury, with a creatinine level of 189 μmumol/l and urea level of 17.8 mmol/l. A renal ultrasound scan reveals normal sized kidneys with no signs of obstruction. After controlling her blood pressure, a renal biopsy is performed.
What are the expected histological features on light microscopy?
A 55-year-old man presents to his GP with complaints of weight loss and increased frequency of stool over the past four months. He had a severe case of influenza one month ago and has been feeling more stressed at work. He also reports ankle swelling and frothy urine. On examination, he has evidence of pitting edema and a 2 cm firm non-tender liver edge. Investigations reveal low hemoglobin, low MCV, elevated ESR, and elevated bilirubin and alkaline phosphatase. CXR shows bilateral pleural effusions. What is the most important investigation to guide further management?
A 70-year-old patient with chronic kidney disease secondary to renovascular disease presents for follow-up. His recent blood work reveals anemia with a hemoglobin level of 102 g/L (130-180) and an MCV of 87 fL (80-96). His eGFR is 15 ml/min/1.73 m2, and he is currently taking oral iron supplements and darbepoetin alfa 60 mg weekly. The patient’s ferritin level is 150 μg/L (15-300), and transferrin saturation is 18% (20-40%). C-reactive protein is <5 mg/L (<10). What is the most appropriate course of action to manage his anemia?
A 49-year-old patient with type 1 diabetes and chronic kidney disease presents for a check-up. His recent blood tests reveal a haemoglobin level of 112 g/L (130-180), MCV of 87 fL (80-96), sodium of 133 mmol/L (137-144), potassium of 4.3 mmol/L (3.5-4.9), urea of 19.1 mmol/L (2.5-7.5), creatinine of 267 μmol/L (60-110), ferritin of 150 μg/L (15-300), C reactive protein of <5 mg/L (< 10), and an eGFR of 24 ml/min/1.73 m2. What is the most appropriate course of action for managing his anaemia?
A 50-year-old man, previously healthy and active, presents to the emergency department with a six-week history of back pain, malaise, and hiccups. He experienced an episode of hematuria three days prior to admission and has no history of respiratory symptoms. On examination, he appears unwell with a pulse of 120, BP 105/80 mmHg, temperature 36.7°C, and oxygen saturation of 95% on air. Laboratory investigations reveal low hemoglobin levels, normal white cell count, low sodium levels, high potassium levels, high urea levels, high creatinine levels, and low pH levels. His ECG shows marked tenting of the T waves. He is urgently transferred for dialysis and further investigations. A chest x-ray shows no signs of heart failure or consolidation. His urine dip is positive for protein and blood only. An ultrasound of the renal tract is normal, but a renal biopsy reveals acute glomerulonephritis with linear immunofluorescence staining. He tests positive for antiglomerular basement membrane antibody, and a diagnosis of Goodpasture’s disease is made. Besides hemodialysis, what other therapeutic modality is likely to be beneficial in the next few days?