A 21-year-old woman of African descent presents to your Nephrology Clinic with a complaint of dipstick-positive proteinuria and lower limb edema. She has no significant medical history and is not taking any regular medication. She reports occasional joint pain in her elbows and knees, which she manages with paracetamol. On examination, her blood pressure is 118/60 mmHg.
What is the most suitable test to determine the underlying diagnosis of this patient?
A 95-year-old woman is discovered on the floor of her apartment by her son. She was last seen three days ago and had complained of feeling unwell with a productive cough.
She is brought to the Emergency department, conscious and alert, for evaluation and treatment. Her vital signs are as follows: temperature 37.6°C, pulse 82, BP 110/70 mmHg, and oxygen saturation 89% on room air.
Upon physical examination, she appears mildly dehydrated and has crackles on the left base of her lung upon auscultation. A chest x-ray confirms a left lobar pneumonia with no significant signs of heart failure. An electrocardiogram is normal, and a renal ultrasound scan reveals no evidence of hydronephrosis with normal-sized kidneys. A urine dipstick test is positive for hematuria only.
Some of her initial laboratory results are as follows:
Hemoglobin 105 g/L (130-180)
White blood cell count 20 × 109/L (4-11)
Sodium 142 mmol/L (135-150)
Potassium 5.3 mmol/L (3.5-5.0)
Urea 16 mmol/L (2.5-7.5)
Creatinine on admission 230 µmol/L (60-110)
Creatinine two weeks ago 70 µmol/L (60-110)
Calcium (corrected) 2.2 mmol/L (2.2-2.6)
Phosphate 1.9 mmol/L (0.8-1.2)
She is started on intravenous fluid replacement and intravenous co-amoxiclav to treat community-acquired pneumonia. What is the next best blood test to determine the cause of her kidney dysfunction?
A 65-year-old woman presents with a four day history of nausea. She has no medication history and her only medical condition is diet controlled diabetes mellitus. Her recent checkup showed no signs of retinopathy or neuropathy, and her creatinine level was 79 µmol/L. Upon admission to the hospital, her blood tests reveal:
– Na 139 mmol/L (137-144)
– K 5.3 mmol/L (3.5-4.9)
– Urea 35.5 mmol/L (2.5-7.5)
– Creatinine 895 μmol/L (60-110)
– Hb 91 g/L (115-165)
Which of the following is most likely to be positive?
A 55-year-old male presents acutely as a primary percutaneous coronary intervention (PPCI) call after sudden onset chest pain of onset 3 hours ago, associated with nausea, vomiting and profuse sweating.
His ECG in the ambulance demonstrates ST elevation noted on V2-V5. His past medical history includes include hypertension, type 2 diabetes mellitus, chronic kidney disease (creatinine baseline = 170 µmol/l at the renal clinic 2 months ago). He is taken straight to the cardiac catheter laboratory, where he undergoes angioplasty and a single drug-eluting stent to his left anterior descending artery. On examination, he is pain-free, warm peripherally without respiratory distress. Capillary refill time is less than 2s and jugular venous pulse at 3 cm above the angle of Louis. His heart sounds and chest are unremarkable. A post-procedure transthoracic echocardiogram demonstrates moderate left ventricular impairment with no valve abnormalities.
At 24 hours after admission, his blood tests are repeated and are as follows:
Hb 92 g/l
WCC 13.5 * 109/l
Plt 198* 109/l
Na 138 mmol/l
K 4.2 mmol/l
Urea 12.9 mmol/l
Creat 254 µmol/l
Trop 0.87 (normal < 0.03)
What is the most appropriate next management step in addition to optimizing hydration status?
A 55-year-old woman presents with a two-day history of nausea and haemoptysis. She is feeling generally well, but has noticed that her urine appears pink. Upon urinalysis, ++++ blood and +++ protein are detected. A chest X-ray reveals diffuse bilateral infiltrates. Blood tests show elevated levels of sodium, potassium, urea, and creatinine. Which of the following is the most likely positive finding?
A 55-year-old man presents to the ‘well man’ clinic due to a family history of his father dying from a heart attack at the age of 61. He has a BMI of 28 kg/m2 and is a smoker of 10-15 cigarettes per day. On examination, his blood pressure is 162/88 mmHg, and fundoscopy shows AV nipping. He is advised to see his general practitioner, who confirms a sustained elevation in blood pressure with recordings averaging 170/94 mmHg. Dipstick urinalysis reveals urine protein (+), and further investigations show elevated levels of creatinine and urea. His total cholesterol and triglyceride levels are also high. Ultrasound of his abdomen shows normal-sized kidneys. What is the most likely cause of his renal impairment?
A 36-year-old man presents to the Endocrine Clinic after routine blood testing at the GP surgery. He has no significant previous medical history; his only recent attendance at the doctor’s was for a minor cold. There was no other past history of note and examination revealed blood pressure of 118/78 mmHg. No previous history of hypertension was noted.
Investigations:
Haemoglobin (Hb) 142 g/l 135 – 175 g/l
White cell count (WCC) 7 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 205 × 109/l 150 – 400 × 109/l
Sodium (Na+) 139 mmol/l 135 – 145 mmol/l
Potassium (K+) 2.8 mmol/l 3.5 – 5.0 mmol/l
Bicarbonate (HCO3-) 30 mmol/l 22 – 29 mmol/l
Creatinine (Cr) 95 μmol/l 50 – 120 µmol/l
Which of the following investigations would be most useful in pointing to the diagnosis?
A 70-year-old man with hypertension and type II diabetes mellitus managed with insulin on a basal-bolus regimen is admitted to the hospital with an acute, right-sided middle cerebral artery stroke. He is not thrombolysed due to hypertension and is transferred to the Stroke Ward for long-term management and rehabilitation. What is the probable underlying diagnosis based on his medical history and investigations?
A 59-year-old man presents with general lethargy and is currently undergoing treatment for bladder cancer complicated by paraneoplastic Guillain-Barré syndrome. Upon examination, there are no significant findings. However, his blood work reveals elevated levels of urea and creatinine, as well as a high CRP. An urgent KUB ultrasound is ordered and shows severe bilateral hydronephrosis. The urinalysis also indicates the presence of nitrites, leucocytes, blood, and protein. What is the most probable cause of his hydronephrosis?
A 26-year-old woman has been referred to your renal outpatient clinic by her general practitioner due to complaints of tiredness. She is not currently taking any medications. During examination, her blood pressure was measured at 180/95 mmHg. Routine investigations by her general practitioner showed normal levels of serum sodium and urea, but low levels of serum potassium and slightly elevated levels of serum creatinine. She was admitted to the hospital for further investigations, which revealed a plasma renin activity of 5.2 pmol/ml/h (1.1-2.7) and a serum aldosterone level of 900 pmol/L (135-400). What is the correct diagnosis?