A 28-year-old man presents with sudden onset severe pain in his right loin. The pain began 3 hours ago just below the right side of his rib cage and has gradually moved down to his right groin, radiating into his right testis. He denies any visible haematuria. He is unable to tolerate physical examination and is writhing around on his bed.
What is the most appropriate initial management?
A 20-year-old African-Caribbean woman with sickle-cell anaemia presents with acute kidney injury. Her only medication is hydroxycarbamide (hydroxyurea).
What is the most probable reason for her condition?
A 58-year-old man is admitted with severe shortness of breath during the early hours of the morning. Past history of note includes difficult-to-manage hypertension, for which he now takes amlodipine 10 mg, indapamide 1.5 mg and doxazosin 8 mg. He failed a trial of ramipril 1 year earlier due to a rise in his creatinine of 40% at the 1-week post-initiation stage. On examination, he has a blood pressure of 185/100 mmHg and a pulse of 100 bpm regular and is in frank pulmonary oedema. When you review his old notes, you find this is the second episode during the past 6 months. Echocardiography has shown a preserved ejection fraction. An electrocardiogram (ECG) reveals no abnormalities.
Which of the following is the most likely diagnosis in this case?
A 63-year-old man presented with fever, body ache and pedal oedema for three months. He was taking oral diclofenac frequently for the aches. He had no other drug history and had not travelled recently.
On examination, there was sternal tenderness. His blood report revealed:
Investigation Result Normal range
Haemoglobin 76 g/l 135–175 g/l
White cell count (WCC) 9 × 109/l 4–11 × 109/l
Erythrocyte sedimentation rate (ESR) 134 mm/hr 0–10mm in the 1st hour
Platelets 280 × 109/l 150–400 × 109/l
Urea 13 mmol/l 2.5–6.0 mmol/l
Calcium 2.8 mmol/l 2.2–2.6 mmol/l
What is the most likely cause of renal failure in this case?
A 16-year-old adolescent presents to the clinic with gross haematuria. He is currently suffering from a sinus infection. Apparently he had a previous episode of haematuria some 2 years earlier which was put down by the general practitioner to a urinary tract infection. Examination of notes from a previous Casualty attendance after a football game revealed microscopic haematuria on urine testing. On examination, his blood pressure is 130/70 mmHg. Physical examination is unremarkable.
Investigations:
Investigation Result Normal value
Haemoglobin 133 g/l 135–175 g/l
White cell count (WCC) 8.2 × 109/l 4–11 × 109/l
Platelets 240 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
Creatinine 110 μmol/l 50–120 µmol/l
Urine Blood ++, protein +
C3 Normal
Serum IgA Slight increase
Which of the following is the most likely diagnosis?
A 72-year-old man comes to the Emergency Department with haematuria and haemoptysis. His vital signs are heart rate 88 bpm, blood pressure 170/110 mmHg, respiratory rate 22 breaths per minute, and temperature 37.8 °C. Urinalysis shows protein and red cell casts. Serum testing reveals antibodies to the glomerular basement membrane. A renal biopsy is conducted.
What is the probable finding in the renal biopsy?
A 6-year-old boy presents to the Emergency Department with periorbital pain, ascites, and oedema. He has no past medical history and is typically healthy, without recent illnesses. Upon examination, his serum urea is elevated and protein in his urine is ++++. What is the probable cause of his symptoms?
A 42-year-old accountant presents to the General Practitioner (GP) with flank pain and an episode of frank haematuria. She has a history of recurrent urinary tract infections (UTIs) and has had similar symptoms before. She attributes this episode to another UTI. She also has hypertension which is well controlled with ramipril.
The doctor is concerned regarding the history of recurrent UTIs, and patient is further investigated for her symptoms with blood tests and ultrasound imaging. Results of the bloods and ultrasound confirms a diagnosis of polycystic kidney disease (PKD).
Which of the following is true regarding PKD?
A 54-year-old woman with a long-standing history of poorly controlled type 2 diabetes mellitus presents to clinic complaining of swelling in her ankles, face and fingers. She states she can no longer wear her wedding ring because her fingers are too swollen. On examination, her blood pressure is 150/90 mmHg; she has pitting oedema in her ankles and notably swollen fingers and face. Her blood results show:
Investigation Results Normal value
Creatinine 353.6 μmol/l 50–120 μmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.0 mmol/l
Phosphate 1.9 mmol/l 0.70–1.40 mmol/l
Parathyroid hormone (PTH) Elevated
Urinalysis 3+ glucose, 3+ protein
Which of the following is the most likely mechanism of this woman’s increased PTH?
A 38-year-old woman with a history of systemic lupus erythematosus and recently diagnosed with CKD stage G3a (GFR 45 ml/min/1.73 m2) is seen by her GP. The GP notes that the patient has a BP of 152/90 mmHg, which is persistently elevated on two further readings taken on separate occasions by the practice nurse. The patient has no past history of hypertension. What is the most appropriate management for the patient’s hypertension?