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A patient in the Emergency Department has the laboratory results shown below:
Which of the following is the most likely cause of the acidosis?
A 16-year-old man presents with facial oedema and dark urine two weeks after a bout of tonsillitis. He has been anuric for 18 hours. Initial investigations confirm acute renal failure with markedly elevated serum urea and creatinine. His serum potassium is elevated at 6.8 mmol/L.
Which of the following intervention is most likely effective in reducing total body potassium?
As glomerular filtration rate (GFR) declines, urinary creatinine clearance overestimates GFR because creatinine is:
Which one of the following drugs may be cleared by hemodialysis?
A 50-year-old man presenting for an insurance medical examination is found to be hypertensive with a resting blood pressure of 170/110 mmHg. He takes no medication.
The following laboratory investigations were obtained while on a normal diet:
Which one of the following diagnoses best fits the clinical picture?
A 35-year-old man is found to be hypertensive with a blood pressure of 180/110 mmHg. At presentation, on no treatment, the following results are obtained:
The most appropriate investigation is to measure:
A 43-year-old woman presents with a six month history of hypertension which has been difficult to control. She is now taking three agents for her blood pressure control. She has a serum potassium of 2.7 mmol/L [3.6 – 5.2 mmol/L] and you are concerned about primary hyperaldosteronism(Conn’s syndrome).
Which of the following medications is most likely to interfere with the interpretation of an aldosterone:renin ratio result?
A patient with primary aldosteronism secondary to a unilateral adrenal hyperplasia undergoes an adrenalectomy.
Which biochemistry marker is most likely to improve post-surgery?
Which of the following is the main site of sodium reabsorption in the nephron?
Which of the following structure is the primary site of action for acetazolamide?
The concomitant use of which medication will increase the risk of lithium toxicity in the blood?
Frusemide blocks which of the following co-transporter?
Which of the following is the correct order of events in the reninangiotensin system in response to low blood pressure?
A) Kidneys reabsorb sodium and water uptake is increased
B) The kidneys sense low blood pressure.
C) Renin is released into the blood and produces Angiotensin I.
D) Release of Aldosterone, ADH, and thirst stimulation.
E) Angiotensin Converting Enzyme (ACE) converts Angiotensin I to Angiotensin II.
A 19 year old girl presents with weakness.She is on no medications and has 4 siblings.One sister has had low potassium levels.Physical exam and BP are normal.
Urine: Na 60, K 50, Cl 100
Prostaglandin E normal
What is the most likely diagnosis?
A 56 year old woman is on hemodialysis for end stage renal failure due to diabetes.
What is the most appropriate treatment?
Erythropoietin is predominantly made from which type of cell in the kidney?
A 65-year-old woman, established on haemodialysis for nine months, is maintained on erythropoietin 4,000 units twice a week intravenously. Previously her haemoglobin (Hb) had remained steady in the range of 105 – 115 gm/L.
She now presents with a Hb of 89 gm/L on routine testing. There have have been no changes to her erythropoietin dose or other medications.
Her iron profile are as follow:
Which of the following is the most likely explanation for her erythropoietin resistance?
A 16-year-old post pubertal boy has chronic renal failure with a serum creatinine of 300 micromol/L due to glomerulonephritis. Two years ago his creatinine was 100 micromol/L and one year ago it was 200 micromol/L.
He wants to complete his schooling in two years time before undergoing pre-emptive living related transplantation. He is growing on the 25th percentile for height and the 10th for weight (having gained height but not weight in the last year). His blood pressure is 140/105 mmHg and he has 2.0 g per day of proteinuria. His dietary protein content is 2 g/kg/day.
His serum chemistry are as follow:
Which one of the following will have no effect on the progression to end-stage renal failure?
What is the predominant cause of anaemia in chronic renal failure?
A 45-year-old woman presents with a three-year history of recurrent rash, characterised as palpable purpura over both legs. Some of these lesions have ulcerated.
Laboratory results include:
Which of the following is the most appropriate management?
A 40-year-old man was found to have elevated liver enzymes and positive hepatitis C serology since 2000. Liver biopsy showed chronic active hepatitis consistent with hepatitis C.
He now presents with purpuric rash on his knee, joint pains and Raynauds phenomenon.
Which one of the following is the most appropriate next investigation?
A 23-year-old woman presents with generalised swelling. Over the last three days she has felt tired, has experienced bilateral loin pain and has noticed darkening of her urine. She has had a skin infection on her knee which has been slow to resolve.
On examination, she has mild generalised oedema, a blood pressure of 170/115 mmHg and tenderness in the loins. The skin lesion is still encrusted and erythematous. Urinalysis shows ++proteinuria and ++blood. Other examination is unremarkable.
Full blood count normal
Serological investigations show:
Apart from control of blood pressure, fluid and electrolyte management and acute dialysis if indicated, the most appropriate therapy for this renal disease is:
A 15-year-old teenager is admitted to hospital because he has been lethargic for the past three to four weeks. He appears to be thirsty all the time with recent weight loss. He has been getting up to pass urine three times each night for the past two weeks. There is no history of drug ingestion or infection. There is no past history of note. Clinical examination is unremarkable.
His initial investigations show the following:
urinalysis 1+ protein, no blood, moderate glucose
urine microscopy 40 white cells,
The most likely diagnosis in this patient is:
A young woman presents with thirst and polyuria. Following overnight water deprivation, which one of the following is the best indicator that she has partial (and central) diabetes insipidus (Arginine Vasopressin Deficiency) rather than psychogenic polydipsia?
A young man is identified as having haematuria (>50,000 red blood cells/mL). This is associated with a trace of protein on urine dipstick testing on several occasions. His blood pressure is 110/70 mmHg and no abnormalities are detected on physical examination.
His serum biochemistry results are as follow:
What is the most likely diagnosis?
Persistent reduction of serum complement component 3 (C3) is most strongly associated with which one of the following forms of glomerulonephritis?
A 56-year-old woman presents with generalised swelling including legs, hands and face and no other relevant history. She has had a normal examination two years prior. Apart from oedema, the only abnormality on current examination is a blood pressure of 170/105 mmHg.
Urinalysis shows protein ++++, blood ++, dysmorphic red cells, red cell casts and granular casts.
Her blood tests are as follow:
What is the most likely renal pathology?
A 16-year-old girl presents to the emergency department with swollen eyes and ankles for one week. She has been lethargic and complained of back and right flank pain for approximately 10 days. Examination reveals a well grown adolescent with blood pressure 120/84 mmHg. She has pitting oedema up to her thighs and her liver is palpable 2 cm below the right costal margin and is tender. Urine microscopy shows 400 red cells, red and white cell casts and 4+ protein.
Blood tests show:
Which one of the following is the most likely diagnosis?
A 45-year-old woman has had six episodes of nephrotic syndrome over the last five years. The initial episodes responded promptly and completely to oral prednisone, but recent episodes have responded more slowly. At the completion of her last course of prednisone two weeks ago, urine protein was 500 mg/day.
The trichrome-stained renal biopsy is shown below.
What is the most likely diagnosis?