A 68-year-old woman was admitted to hospital seven days ago with moderate symptoms of community-acquired pneumonia and was treated with amoxicillin. She has developed a fever, maculopapular skin rash and haematuria over the last two days. You suspect that her new symptoms may be due to acute tubulointerstitial nephritis caused by a reaction to the amoxicillin she was given.
Which of the following investigations would provide a definitive 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 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?
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 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 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 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 patient with chronic kidney disease has a creatinine of 350 μmol/l and has persistent proteinuria.
Which one of the following drugs is most likely of benefit to his renal prognosis?
A 49-year-old man, with known polycystic kidney disease (PKD), presents with acute-onset fever, left mid-back pain and occasional chills. He has no dysuria or haematuria. The left renal angle is tender. The white cell count is 27.8 × 109/l, with 92% of neutrophils (54–62%). What is the most appropriate diagnostic tool to confirm the suspected diagnosis?
An 80-year-old woman with a history of cervical carcinoma has been brought to the Emergency Department in a confused and dehydrated state. Her blood tests reveal significant abnormalities, including a potassium level of 7.2 mmol/l (NR 3.5–4.9), creatinine level of 450 μmol/l (NR 60–110), and urea level of 31.2 mmol/l (NR 2.5–7.5). Upon retesting, her serum potassium remains elevated. What is the most appropriate initial management for this patient?