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?
A 52-year-old man with an acute kidney injury has developed fluid overload and treatment has been initiated. An ABCDE assessment is performed, and the findings are below:
Airway Patent, speaking but confused in conversation
Breathing Respiratory rate (RR) 24/min, SaO2 96% on 4 litres of O2/min, bibasal crackles heard on auscultation in the lower zones (up to mid-zones on admission)
Circulation Heart rate (HR) 112 bpm, blood pressure (BP) 107/68 mmHg, heart sounds disturbed by a friction rub, ECG shows sinus tachycardia
Disability Pupils equal and reactive to light, normal upper and lower limb neurology, Glasgow Coma Scale (GCS) 14 (E4 V4 M6)
Exposure Temperature 36.8°C
On initial bloods, the C-reactive protein (CRP) is within normal limits.
The results of initial arterial blood gas and serum urea and electrolytes are shown below:
Investigation Result Normal value
pH 7.28 7.35–7.45
pO2 10.7 kPa > 11 kPa
pCO2 5.7 kPa 4.5–6.0 kPa
Bicarbonate 20 mmol/l 22–26 mmol/l
Lactate 1.8 mmol/l < 2 mmol/l
Urea 53 mmol/l 2.5–7.8 mmol/l
Creatinine 729 µmol/l 50–120 µmol/l
Which one of the following is an indication for urgent dialysis in this patient?
A 76-year-old woman is admitted to the hospital feeling generally unwell. She has also developed a fever and diffuse erythematous rash over the last few days. Urinalysis is positive for blood and protein, and blood tests show raised eosinophils and creatinine. Her General Practitioner started her on a new medication two weeks ago, but she cannot remember the name or what it was for.
Which of the following drugs would be safe to continue at present, given the suspected diagnosis?
A 50-year-old man with long-standing insulin-dependent diabetes mellitus was on dialysis, secondary to end-stage renal disease (ESRD). Three months ago, he received a kidney transplant, with his old kidney left in place. The transplanted kidney is attached to the central circulation, mimicking natural circulation. There are absolutely no signs of rejection, and the kidney is working perfectly. The patient is surprised to find out that he no longer has ‘thin blood’ because it has been years since he has not required medical management for his anaemia.
What is the main factor responsible for the normalization of his blood parameters and his recovery, following the kidney transplant?
What ultrasound marker is most strongly linked to an elevated risk of trisomy 21 in the developing fetus?
A 70-year-old woman with type II diabetes mellitus presents to the Emergency Department. She was found to be confused at home by her son. According to her son, the patient is independent and able to take care of herself. On examination she has a temperature of 38.1 °C. Her blood pressure is 136/74 mmHg, and her heart rate is 110 bpm. She is disorientated and not able to provide any history. Physical examination is unremarkable except for tenderness elicited at the right lower back.
Urine dipstick results are shown below:
Investigation Result Normal value
Colour Turbid Clear
pH 6.7 7.35–7.45
Glucose 2+ Negative
Bilirubin Negative Negative
Ketone 1+ Negative
Nitrite 2+ Negative
Leukocytes 3+ Negative
Blood 1+ Negative
Which of the following is the most likely diagnosis?
A 4-year-old child is brought to their General Practitioner (GP) with failure to thrive. His parents complain that he drinks a lot of water and urinates frequently and is not growing very well. The GP does blood and urine tests and diagnoses Fanconi syndrome.
Which of the following features would you most likely see in Fanconi syndrome?
A 35-year-old woman with haematuria underwent a kidney biopsy, but light microscopy results were inconclusive. As a result, the specimen was sent for electron microscopy. Which renal disease requires electron microscopy for diagnosis?
A 43-year-old man is suspected of having a renal calculus. He has some investigations carried out by the general practitioner to monitor the effects of his medication. The following results are obtained:
Plasma
Na+ 138 mmol/l (135–145 mmol/l)
K+ 3.1 mmol/l (3.5–5 mmol/l)
24-hour urine sample:
Ca2+ 40 mg/day (100–300 mg/day)
Given the results above, which one of the following is the patient most likely taking?