A 65-year-old male patient arrives at the Emergency department with a general feeling of unwellness. Upon reviewing his medication list, you notice that he is taking acetazolamide, a carbonic anhydrase inhibitor. A blood gas analysis is performed. What acid/base imbalance can acetazolamide potentially induce?
A 56-year-old woman has been admitted to the hospital with concerns of possible lupus nephritis after recent blood tests showed an acute kidney injury. Her medical history includes systemic lupus erythematosus (SLE), two prior transient ischaemic attacks, hypertension, and obesity. She regularly takes hydroxychloroquine, clopidogrel, and ramipril.
The renal team plans to perform a renal biopsy to investigate the presence of lupus nephritis and has requested an ultrasound before the procedure.
Renal Ultrasound: The right renal pelvis appears dilated, raising concerns for hydronephrosis. There is no visible obstruction or underlying collection. Both kidneys appear atrophic.
What is an absolute contraindication to the procedure?
A 63-year-old man, who has been undergoing long-term haemodialysis for end-stage kidney disease due to type 1 diabetes, presents to the clinic with complaints of pain and tingling in his hands, particularly in the early hours of the morning. He also experiences difficulty with dysphagia and indigestion, and an echocardiogram performed for decreased LV function revealed a suspicion of early constrictive pericarditis. During further questioning, he admits to drinking a glass of whisky each evening. On examination, there is weakness of thumb abduction, apposition, and flexion, and some sensory loss is suspected. Based on the investigations provided, what is the most likely cause of his upper limb neurological symptoms?
A 32-year-old man of Nigerian origin presented to his primary care physician with six months of fatigue and decreased appetite. He has a family history of kidney disease, with his father and two uncles requiring dialysis.
During the physical examination, the physician noted a blood pressure of 190/110 mmHg and a palpable mass in the abdomen. The patient underwent routine blood tests and an abdominal ultrasound.
Results:
Ultrasound scan Enlarged kidneys with multiple cysts, consistent with polycystic kidneys
Haemoglobin 130 g/l 130–170 g/l
White cell count (WCC) 7 × 109/l 4–11 × 109/l
Platelets 300 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 5.8 mmol/l 3.5–5.0 mmol/l
Urea 14.5 mmol/l 2.5–6.5 mmol/l
Creatinine 700 µmol/l 50–120 µmol/l
What is the most likely diagnosis for this patient?
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 67-year-old man presents to the emergency department complaining of pain in his right forearm. He has a medical history of hypertension and end-stage renal failure and is currently taking ramipril, amlodipine, and doxazosin.
Upon examination, an arteriovenous fistula is observed in the right forearm, with an audible bruit. No other swelling or erythema is present, and there is no pain when the forearm is moved passively. The hand’s color appears normal.
What is the probable diagnosis?
A 65-year-old woman presented to the hospital with haematuria and other symptoms. She had been feeling unwell for a few weeks with vomiting, weight loss, fevers, and lethargy. The day before admission, she experienced haematuria with reduced urine output. She had no prior medical history but was an ex-smoker and worked as a retail shop manager. On examination, she appeared pale and lethargic with mild peripheral oedema. Her chest was clear, and her abdomen was soft and non-tender with no palpable masses.
The following investigations were conducted:
– Urine dip: blood+++, protein++
– Haemoglobin: 86 g/L
– White cell count: 8.7 x10^9/L
– Platelet Count: 201×10^9/L
– INR: 1.0
– Serum sodium: 139 mmol/L
– Serum potassium: 6.3mmol/L
– Serum urea: 34.0mmol/L
– Serum creatinine: 789 micromol/L
– CRP: 32
– Antinuclear antibody: negative
– Anti-neutrophil cytoplasmic antibody: negative
– Anti-glomerular basement membrane antibody: positive
Based on the results, she was diagnosed with renal limited anti-GBM disease and started on methylprednisolone and cyclophosphamide. What other treatment options should be considered?
A 70-year-old man is rushed into emergency surgery for an abdominal aortic aneurysm repair. You are called to assess him three days later in the surgical high-dependency unit. Upon examination, he appears drowsy but has a Glasgow coma scale of 15/15. His blood pressure is 150/90 mmHg, and his central venous pressure recording (CVP) is +14 cm H2O.
Further investigations reveal the following results:
– Serum sodium: 132 mmol/L (137-144)
– Serum potassium: 5.9 mmol/L (3.5-4.9)
– Serum urea: 32.8 mmol/L (2.5-7.5)
– Serum creatinine: 520 µmol/L (60-110)
– Urinary sodium: 58 mmol/L
– Urine volume: 320 ml/24 hr
– Urine osmolality: 280 mOsmol/L
An ultrasound scan shows that the left kidney measures 12.7 cm in length, and the right kidney measures 11.5 cm in length.
What clinical finding would suggest a diagnosis of acute tubular necrosis (ATN) rather than pre-renal failure?
A 15-year-old boy presents with headache, nausea, and vomiting. He had been healthy prior to the onset of symptoms, which worsened over the past 12 hours. Upon admission, he appears slightly confused, has a temperature of 39 degrees Celsius, and exhibits a positive Kernig’s sign and a faint purpuric rash on his knees. His blood pressure is 90/60 mmHg, and his pulse is 120 beats per minute. A CT head scan and lumbar puncture confirm a diagnosis of meningococcal meningitis, and he is admitted to the intensive care unit and treated with IV cefotaxime 2 g tds and benzylpenicillin 2.4 g qds. His admission is complicated, requiring intubation, ventilation, and hypotensive episodes. On the second day of his admission, his urine output decreases, with an hourly output of approximately 10 ml/hr.
Further investigations reveal:
– Haemoglobin: 167 g/L (115-165)
– White cell count: 16.8 ×109/L (4-11)
– Platelets: 100 ×109/L (150-400)
– Serum sodium: 125 mmol/L (137-144)
– Serum potassium: 5 mmol/L (3.5-4.9)
– Serum urea: 6.7 mmol/L (2.5-7.5)
– Serum creatinine: 100 µmol/L (60-110)
– Plasma osmolality: 300 mosmol/Kg (278-305)
– Urine osmolality: 285 mosmol/Kg (350-1000)
– Urine urea: 120 mmol/L
– Urine sodium: 75 mmol/L
Why is this case indicative of acute tubular necrosis rather than pre-renal failure?
A 55-year-old man presents to the emergency department with complaints of nausea and lethargy two weeks after starting omeprazole for gastro-oesophageal reflux. His blood work reveals a hemoglobin level of 121 g/L (130-180), elevated eosinophils at 0.52 ×109/L (0.04-0.4), high creatinine levels at 395 μmol/L (60-110), and low bicarbonate levels at 20 mmol/L (20-28). Additionally, his urinalysis shows +++ blood, +++ leucocytes, and + protein. What is the most likely diagnosis?