MSRA Category: Renal Medicine/Urology

MSRA-2392

A 68-year-old man with chronic kidney disease (CKD) stage 3a with proteinuria has hypertension which is not controlled with amlodipine.
Which of the following other agents should be added?

MSRA-2377

A 60-year-old woman has blood tests done by her primary care physician during a routine check-up. The results show a decline in her renal function. Upon further examination, she reports experiencing ankle swelling and increased fatigue. The renal team suspects she may have amyloidosis. What diagnostic test could be used to confirm this diagnosis?

MSRA-2378

A 36-year-old woman attends surgery concerned that her 42-year-old brother has recently been diagnosed with adult polycystic kidney disease (PKD). She read online that it can run in families and is asking to be tested to ensure she does not have the condition.
Which of the following tests is best to perform?

MSRA-2379

A 55-year-old woman presents to her General Practitioner with headaches and is found to have a blood pressure of 170/90 mmHg. She is a non-smoker and has a history of diabetes. Renal artery stenosis is suspected as the underlying cause of her condition.
Which of the following tests is the gold-standard investigation for diagnosis of this condition?

MSRA-2380

A 30-year-old man presents to the General Practitioner (GP) with hypertension which fails to fall into the normal range after three successive measurements at the practice nurse. These were 155/92 mmHg, 158/96 mmHg and 154/94 mmHg. He has a past history of some urinary tract infections as a child. The GP arranges some routine blood tests.
Investigations reveal the following:
Investigation Result Normal value
Haemoglobin (Hb) 139 g/l 135–175 g/l
White cell count (WCC) 5.4 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 201 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 187 μmol/l 50–120 μmol/l
Ultrasound scan (USS) Left kidney 8.4 cm and appears scarred.
Right kidney 10.3 cm
Which of the following is the most likely diagnosis?

MSRA-2381

A 25-year-old man presents with a complaint of generalised swelling that has affected his legs, arm and face, worsening over the last three weeks. Upon investigation, the following results were obtained: Sodium (Na+) 139 mmol/l (normal range: 135–145 mmol/l), Potassium (K+) 4.2 mmol/l (normal range: 3.5–5.0 mmol/l), Creatinine (Cr) 190 μmol/l (normal range: 50–120 μmol/l), Urea 14.8 mmol/l (normal range: 7–20 mmol/l), Alanine aminotransferase (ALT) 20 IU/l (normal range: 29–33 IU/l), Bilirubin 16 μmol/l (normal range: < 20.5 μmol/l), Albumin 19 g/l (normal range: 35–50 g/l), Total Cholesterol 9.2 mmol/l (normal range: < 5.2 mmol/l), Prothrombin time (PT) 10 s. What is the most likely diagnosis?

MSRA-2382

A 65-year-old patient with hypertension is brought to his general practitioner by his daughter because of haematuria. While taking the history, it becomes apparent that he has had blood in his urine for the past two months and it has gotten progressively worse. Now he also has left flank pain. He has lost 8 lb in the past month without trying. He denies dysuria, fever, nausea and chills. His family history is significant only for ‘diabetes’ in both parents. He has a 40-pack-year history, drinks an occasional glass of wine and denies any history of illicit drug use.
On examination, he is afebrile and his vital signs are stable. On deep palpation of his left upper quadrant, there is a firm, non-mobile mass.
What is the most likely diagnosis?

MSRA-2383

A 65-year-old woman is discharged following an uncomplicated renal transplant for end-stage renal failure from hypertension. She received a kidney with 4 out of 6 mismatched human leukocyte antigen (HLA) and is taking the appropriate medications. Thirty days postoperatively, she developed watery loose stools, followed by a skin rash that is itchy, painful and red. On examination, she has a red-violet rash affecting her hands and feet.
Investigations reveal the following:
Investigation Result Normal value
Haemoglobin (Hb) 131 g/l 115–155 g/l
White cell count (WCC) 5.4 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 280 ×109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Urea 15.1 mmol/l 2.5–6.5 mmol/l
Creatinine (Cr) 170 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 54 IU/l 7–55 IU/l
Alkaline phosphatase (ALP) 165 IU/l 30–130 IU/l
Bilirubin 62 µmol/l 2–17 µmol/l
Which of the following is the most likely diagnosis?

MSRA-2384

A 72-year-old man undergoes a new-patient screen by his general practitioner (GP) and is found to have microscopic haematuria. The GP also observes a raised erythrocyte sedimentation rate (ESR) and a calcium concentration of 3.1 mmol/l (reference range 2.2–2.7 mmol/l). During the examination, the patient is noted to have a varicocele. What is the most likely diagnosis based on these findings?

MSRA-2385

A 32-year-old woman presents with flank pain and a 48-hour history of dysuria. Her past medical history includes polycystic ovary syndrome. She is not sexually active at present. There is haematuria on urine dipstick testing. Examination reveals a pyrexia of 38.1 °C and flank pain.
What diagnosis fits best with this clinical picture?