A 72-year-old man with chronic kidney disease is in his seventh year of haemodialysis (HD). He visits his general practitioner with symptoms of pain, numbness and tingling in both hands during the early hours of the morning. He also complains of stiffness in his shoulders, hips and knees.
What diagnosis fits best with this clinical picture?
A 26-year-old man undergoes a routine medical examination and is found to have 3+ haematuria. This is confirmed on microscopy and on a second urinalysis 9 months later. He recalls experiencing two episodes of red urine in the past year, both of which occurred during upper respiratory tract infections. There is no family history of renal disease. He has no oedema but his blood pressure is 150/100 mmHg. His plasma creatinine level is 65 μmol/l (reference range 53–106 μmol/l). What is the most likely finding on a renal biopsy?
A 55-year-old woman presents to the Emergency Department with blood-stained urine and coughing up blood.
On examination, her temperature is 38.2 °C. Her blood pressure is 160/100 mmHg, while her pulse is 92 beats per minute. Her respiratory rate is 20 breaths per minute. Urine testing is positive for protein and red cell casts. Antibodies to the glomerular basement membrane are found on serum testing. A renal biopsy is performed.
What is likely to be seen on the renal biopsy?
A 30-year-old woman with a family history of renal disease presents with gross haematuria. She reports that her sister recently underwent a kidney transplant and that her mother passed away due to renal failure. During physical examination, a significant mass is palpated in the left lumbar region, and a smaller mass is felt in the right flank. Elevated levels of blood urea and serum creatinine are observed.
What is the most likely diagnosis?
A 55-year-old woman presents with haematuria, left flank pain and fatigue. Physical examination reveals a mass in the left flank. Blood tests show hypochromic anaemia.
What is the most probable diagnosis?
An 83-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 for a painful and swollen knee joint 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 35-year-old man presents with haematuria and severe left flank pain. He is agitated and unable to find a position that relieves the pain. On examination, his abdomen is soft with tenderness over the left lumbar region. He has no fever.
What is the likely diagnosis?
A 68-year-old woman visits her general practice for a routine check-up. She has a history of hypertension and occasional headaches. During screening tests, her serum creatinine level is found to be elevated at 190 μmol/l (reference range 53–106 μmol/l) and her haemoglobin level is low at 110 g/l (reference range 120–155 g/l). An X-ray of her chest shows a mass in her lung, and there is a monoclonal band on serum protein electrophoresis.
What is the most likely cause of her impaired renal function?
A 50-year-old man with a history of type 2 diabetes mellitus comes in for a routine check-up. Upon examination, he appears healthy with no abnormal findings except for his blood pressure, which is measured at 160/110 mmHg. Routine blood tests are conducted and reveal the following results:
– Na+ 139 mmol/L (135 – 145)
– K+ 4.5 mmol/L (3.5 – 5.0)
– Urea 16 mmol/L (2.0 – 7.0)
– Creatinine 163 µmol/L (55 – 120)
What additional factor would indicate that the cause of this presentation is chronic rather than acute?
A 56-year-old woman presents to the Emergency Department with severe loin to groin pain that had been intermittent throughout the day. She tells the doctor that she has a previous history of gout.
What is the most appropriate investigation?