MSRA Category: Renal Medicine/Urology

MSRA-2355

A 68-year-old woman visits her GP complaining of urinary frequency and dysuria that has been present for 2 days. Upon urine dip, she tests positive for blood, leucocytes, nitrites, and protein. Her medical history includes rheumatoid arthritis treated with methotrexate and hypertension treated with ramipril. She has no known allergies. The patient is worried because she has been cautioned about an antibiotic that she should avoid due to her current medications.
What medication has she been warned about from the list provided?

MSRA-2356

A 50-year-old male presents for a routine check-up and his blood pressure is found to be 170/100 mmHg (and high blood pressure is confirmed during home blood pressure readings.) He is investigated for secondary causes, none are found, and a diagnosis of primary hypertension is made. His GP starts him on 5mg lisinopril. Two weeks later, his kidney function results show:
Na+ 140 mmol/L (135 – 145)
K+ 4.5 mmol/L (3.5 – 5.0)
Bicarbonate 28 mmol/L (22 – 29)
Urea 7 mmol/L (2.0 – 7.0)
Creatinine 200 µmol/L (55 – 120)

Which of the following is the most likely explanation for the improvement in his renal function?

MSRA-2357

A 70-year-old man with a 25 year history of type 2 diabetes mellitus presents for a check-up. He was diagnosed with chronic kidney disease (secondary to diabetes) 7 years ago and has experienced a gradual decline in renal function since. His current medications include lisinopril 20 mg daily, amlodipine 5mg daily, atorvastatin 20 mg daily, and NovoRapid insulin twice daily.

His most recent renal function tests reveal the following results:
– Sodium: 140 mmol/L
– Potassium: 5.1 mmol/L
– Urea: 9.8 mmol/L
– Creatinine: 130 µmol/L
– eGFR: 38 mL/min/1.73m²

During his clinic visit, his blood pressure is measured at 154/90 mmHg and this is confirmed on a second reading. What adjustments should be made to his blood pressure medication?

MSRA-2358

A 67-year-old male with type 2 diabetes presents for a check-up. He is currently on metformin 1g twice daily and gliclazide 160 mg twice daily. His BMI is 29 kg/m². Blood tests are taken.
Sodium 140 mmol/L
Potassium 4.0mmol/L
Urea 5.8mmol/L
Creatinine 135 umol/L
eGFR 44 ml/min/1.73m²
HbA1c 7.5% (58 mmol/mol)
What modification to his current treatment plan is recommended based on the provided information?

MSRA-2359

You are examining test results. The midstream urine specimen (MSU) of a 26-year-old woman who is 14 weeks pregnant indicates a urinary tract infection. During the discussion of the outcome with the patient, she reports experiencing dysuria and having ‘foul-smelling urine.’ What is the best course of action?

MSRA-2360

A 65-year-old man with chronic kidney failure has been instructed by his nephrologist to adhere to a ‘renal diet’. He visits you to gain further knowledge about this. What is typically recommended to individuals with chronic kidney disease?

MSRA-2345

A 55-year-old female patient who visits your clinic regularly presents after routine blood tests following the initiation of ramipril for her hypertension. Her clinic BP was 145/98 mmHg before starting ramipril, and her baseline creatinine was 100 umol/L. During her recent visit, her clinic BP was well controlled at 132/84 mmHg, but her creatinine level had increased to 125 umol/L. What is the best course of action for managing her hypertension?

MSRA-2346

A 35-year-old woman who is 8 weeks pregnant visits the early pregnancy unit drop-in clinic complaining of dysuria and increased urinary frequency for the past 2 days. The results of her urine dipstick test are as follows: Leucocytes +++, Nitrites +, Protein -, pH 5.0, Blood +, Ketones -, Glucose -. What is the recommended treatment for her condition?

MSRA-2347

A 26-year-old man with a family history of adult polycystic kidney disease approaches his GP for screening. What would be the most suitable screening test?

MSRA-2348

A 50-year-old woman with type 1 diabetes mellitus is seen in the diabetes clinic. Her blood tests from three months ago showed:
K+ 4.5 mmol/l
Creatinine 116 µmol/l
eGFR 47 ml/min
She was started on lisinopril to manage hypertension and protect her kidneys. The medication was titrated up to the treatment dose. Her current blood results are:
K+ 4.9 mmol/l
Creatinine 123 µmol/l
eGFR 44 ml/min
What is the most appropriate action to take in this situation?