A 59-year-old man has been admitted to the medical receiving unit with a GI bleed. His medical history includes a functioning renal transplant. The patient is stable, but his haemoglobin level is 67 g/L and a blood transfusion is necessary. The transfusion laboratory asks if there are any specific requirements for the transfusion. What would you request?
A 45-year-old man with chronic kidney disease stage 5 due to autosomal-dominant polycystic kidney disease presents to the general nephrology clinic with complaints of increasing fatigue. He denies any changes in bowel habits or weight loss. On examination, his blood pressure is 120/56 mmHg, heart rate is 56 bpm, respiratory rate is 18/min, and Sats are 99% on air. His abdomen is soft and non-tender with palpable kidneys and an irregular liver edge. He is euvolemic.
Lab results show a hemoglobin level of 78 g/l, platelets of 167 * 109/l, WBC of 7 * 109/l, and ferritin of 95 ng/mL. B12 and folate levels are within normal range.
What is the most appropriate next step?
A 24-year-old man with coeliac disease and on oral dapsone presents with persistent microscopic haematuria. His initial investigations show red cell casts in urine microscopy and mesangial proliferation in renal biopsy light microscopy. His blood pressure, haemoglobin, white cell count, platelets, immunoglobulin levels, electrolytes, liver function tests, and albumin are within normal limits, but his 24-hour urinary protein collection is elevated at 1.8 g/24 h. What is the most likely diagnosis?
A 55-year-old man presents to the renal outpatient department with complaints of fatigue and shortness of breath. He has a medical history of end-stage renal failure due to hypertension and is currently undergoing dialysis. His medication regimen includes ramipril, amlodipine, and doxazosin. On examination, an arterio-venous fistula is noted at his right forearm.
The patient’s blood tests reveal a hemoglobin level of 84 g/L (male: 135-180, female: 115-160), MCV of 85 fL (80-96), platelets of 189 * 109/L (150-400), WBC of 4.4 * 109/L (4.0-11.0), Na+ of 138 mmol/L (135-145), K+ of 4.8 mmol/L (3.5-5.0), urea of 28.1 mmol/L (2.0-7.0), ferritin of 88 µg/L (24-336), and transferrin saturation (TSAT) of 12% (20-50).
What would be the appropriate management strategy for this patient?
A 16-year-old girl is admitted to the Acute Medical Unit with a 4-day history of vomiting and persistent diarrhoea accompanied by cramping abdominal pain. She has noticed fresh blood in her stool and is having difficulty maintaining her oral intake. She reports a weight loss of 1-2kg. She has no previous medical history.
Upon examination, she has a temperature of 38.5ºC and a heart rate of 122 bpm with a blood pressure of 100/70 mmHg. Her chest sounds are clear and heart sounds are normal. She has reduced skin turgor and dry mucous membranes. She is generally tender over her entire abdomen, but there is no guarding or palpable masses.
Investigations:
Hb 115 g/L Male: (135-180)
Female: (115 – 160)
Platelets 102 * 109/L (150 – 400)
WBC 15.2 * 109/L (4.0 – 11.0)
Na+ 147 mmol/L (135 – 145)
K+ 5.6 mmol/L (3.5 – 5.0)
Urea 12.8 mmol/L (2.0 – 7.0)
Creatinine 183 µmol/L (55 – 120)
CRP 155 mg/L (< 5)
Blood film: schistocytes.
What is the most appropriate next investigation given the likely diagnosis?
A 72-year-old man visits the renal transplant clinic for follow-up. He underwent a transplant 15 years ago and his graft function has been consistent. He reports experiencing right upper-quadrant abdominal pain lately and has lost 7 kg in the past three months. Upon examination, his blood tests reveal:
– Sodium: 139 mmol/L (137-144)
– Potassium: 3.8 mmol/L (3.5-4.9)
– Urea: 7.2 mmol/L (2.5-7.5)
– Creatinine: 118 μmol/L (stable) (60-110)
– Hb: 113 g/L (130-180)
– ALT: 152 U/L (5-35)
– ALP: 620 U/L (45-105)
What is the most probable diagnosis?
A 70-year-old Indian male presents with left loin pain and occasional frank haematuria. He reports the symptoms started 3 months ago during a visit to Mumbai but have been getting progressively worse over the past 5 days. He also reports gradual weight loss and reduced appetite as well as a non-productive cough.
His past medical history includes type 2 diabetes mellitus, hypertension and hypercholesterolaemia. On examination, his temperature is 37.8 degrees and he is haemodynamically stable.
Abdominal examination reveals a significant swelling in his left scrotum, which does not empty on lying flat. The abdomen is otherwise soft and bowel sounds are present are normal. Lastly, bilateral lower limb swelling is noted to the top of both thighs. A urine dip reveals pH 6.5 4+ blood 1+ protein 1+ leucocyte 1+ nitrite. An initial chest radiograph reveals multiple round opacities in both lung fields. Blood tests are awaited.
Which diagnostic test is most likely to uncover the underlying condition?
A 36-year-old man of African descent presented to the HIV clinic for a routine check-up. He had been on HAART for 4 years but admitted to frequently forgetting to take his medication.
During the examination, the patient was found to have pitting edema in both ankles. A urinalysis performed in the clinic showed 4+ protein and 1+ blood.
Further blood tests revealed a CD4 count of 130 cells/mm3 (normal range: 500-1500) and normal serum complement levels. A renal biopsy was performed, which showed collapsing FSGS.
What is the most likely diagnosis for this patient?
A 57 year-old woman comes in for her annual diabetic check-up. She has been diagnosed with type 2 diabetes mellitus for 13 years and is currently only taking metformin for her diabetes. During her last diabetes check-up 1 week ago, her HbA1c was found to be 40 mmol/mol. She has a medical history of peripheral vascular disease and migraine. Additionally, she has a smoking history of 20 pack years and drinks 5-10 units of alcohol per week. Upon examination, her pulse rate is 86 beats per minute and her blood pressure is 126/70 mmHg. Blood tests reveal a sodium level of 140 mmol/l, potassium level of 3.4 mmol/l, urea level of 7.0 mmol/l, and creatinine level of 105 µmol/l. Urinalysis shows negative results for protein, glucose, leucocytes, and nitrites. However, a 24-hour urine sample indicates 190 mg of albumin in her urine.
What would be the most appropriate next step in managing her renal function?
A 54-year-old man presents to the Emergency Department referred by his General Practitioner due to abnormal renal profile results. The patient’s laboratory results show Na+ 140 mmol/l, K+ 3.4 mmol/l, Urea 25.2 mmol/l, and Creatinine 380 µmol/l. The patient has a medical history of neurofibromatosis type 1, hypertension, and type 2 diabetes mellitus. Despite controlling hypertension and diabetes with diet alone, the patient started taking amlodipine, irbesartan, and metformin two weeks ago. Urinalysis is negative for blood, protein, and nitrites. What is the most likely diagnosis?