Kidney diseases — MCQs

A 63-year-old man presents with a 2-month history of increasing sensation of fullness involving his left flank. The patient reports recent episodes of constant pain. The patient is hypertensive (145/90 mm Hg) and is currently on medications including losartan and hydrochlorothiazide. His past medical history is otherwise unremarkable. He is a 30-pack-year smoker. His temperature is 37.7°C (99.9°F); pulse, 76/min; and respiratory rate, 14/min. Palpation of the left flank shows a 10 x 10-cm mass. The patient's laboratory parameters are as follows: Blood Hemoglobin 19.5 g/dL Leukocyte count 5,000/mm3 Platelet count 250,000/mm3 Urine Blood 2+ Protein negative RBC 45/hpf without dysmorphic features Abdominal CT scan confirms the presence of a large solid mass originating in the left kidney. These findings are most consistent with which of the following conditions?

A 32-year-old woman comes to the physician because of flank pain, myalgia, and reddish discoloration of her urine for the past 2 days. One week ago, she had a fever and a sore throat and was prescribed antibiotics. She is otherwise healthy and has no history of serious illness. Her temperature is 37.9°C (100.2°F), pulse is 70/min, and blood pressure is 128/75 mm Hg. Physical examination shows a soft abdomen and no costovertebral angle tenderness. Examination of the mouth and pharynx shows no abnormalities. There is a faint maculopapular rash over the trunk and extremities. Serum creatinine is 2.4 mg/dL. Urinalysis shows: Protein 2+ Blood 2+ RBC 20–30/hpf WBC 12/hpf Bacteria none Which of the following is the most likely diagnosis?

A 32-year-old woman presents to the office with complaints of frothy urine and swelling in her body that started 6 days ago. She says that she first noticed the swelling in her face that gradually involved other parts of her body. On further questioning, she gives a history of rheumatoid arthritis for 2 years. She is taking Penicillamine and Methotrexate for the past 6 months. Vitals include: blood pressure 122/89 mm Hg, pulse rate 55/min, temperature 36.7°C (98.0°F), and a respiratory rate 14/min. On examination, there is generalized pitting edema along with some subcutaneous nodules on the dorsal aspect of the forearm. Urinalysis pH 6.6 Color light yellow RBC none WBC 1–2/HPF Protein 4+ Cast fat globules Glucose absent Crystal none Ketone absent Nitrite absent 24 hours urine protein excretion 4.8 g Basic metabolic panel Sodium 141 mEq/L Potassium 5.1 mEq/L Chloride 101 mEq/L Bicarbonate 22 mEq/L Albumin 3.2 mg/dL Urea nitrogen 17 mg/dL Creatinine 1.3 mg/dL Uric Acid 6.8 mg/ dL Calcium 8.9 mg/ dL Glucose 111 mg/dL A renal biopsy is ordered which shows diffuse capillary and glomerular basement membrane thickening. Which of the following is the most likely cause for her impaired renal function?

A 57-year-old man comes to the emergency department because of pain in the sides of his abdomen and blood-tinged urine since the previous night. Over the last 2 days, he has also had progressive malaise, myalgia, and a generalized itchy rash. He has a history of gastroesophageal reflux that did not respond to ranitidine but has improved since taking pantoprazole 2 months ago. He occasionally takes acetaminophen for back pain. His vital signs are within normal limits. Examination shows a generalized, diffuse maculopapular rash. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 13 g/dL Leukocyte count 7,800/mm3 Serum Na+ 140 mEq/L Cl- 105 mEq/L K+ 4.6 mEq/L HCO3- 25 mEq/L Glucose 102 mg/dL Creatinine 4.1 mg/dL Renal ultrasonography shows no abnormalities. Which of the following findings is most likely to be observed in this patient?

A female infant is born with a mutation in PKD1 on chromosome 16. An abdominal ultrasound performed shortly after birth would most likely reveal which of the following?

A 6-year-old boy is brought to the physician because of increasing swelling around his eyes for the past 3 days. During this period, he has had frothy light yellow urine. He had a sore throat 12 days ago. He appears tired. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 105/65 mm Hg. Examination shows periorbital edema and pitting edema of the lower extremities. Cardiopulmonary examination shows no abnormalities. Which of the following findings on urinalysis is most likely associated with this patient's condition?

A 34-year-old female presents to her primary care physician with complaints of fevers, nausea/vomiting, and severe left flank pain that has developed over the past several hours. She denies any prior episodes similar to her current presentation. Physical examination is significant for a body temperature of 39.1 C and costovertebral angle tenderness. A urinalysis and urine microscopy are ordered. Which of the following findings on kidney histology would be expected in this patient?

A 35-year-old male with a history of hypertension presents with hematuria and abdominal discomfort. Ultrasound and CT scan reveal large, bilateral cysts in all regions of the kidney. What is the most likely diagnosis?

A 36-year-old man comes to the physician for a 4-week history of swollen legs. He has difficulty putting on socks because of the swelling. Two years ago, he was diagnosed with sleep apnea. He takes no medications. He emigrated from Guatemala with his family when he was a child. He is 171 cm (5 ft 6 in) tall and weighs 115 kg (253 lb); BMI is 39 kg/m2. His pulse is 91/min and blood pressure is 135/82 mm Hg. Examination shows periorbital and bilateral lower extremity edema. Serum Albumin 3.1 g/dL Total cholesterol 312 mg/dL Urine Blood negative Protein +4 RBC 1-2/hpf RBC cast negative Fatty casts numerous A renal biopsy is obtained. Which of the following is most likely to be seen under light microscopy of the patient's renal biopsy specimen?

A 15-year-old Caucasian male is brought to his pediatrician by his parents, who note the development of a tremor in their child. Urine and serum analysis reveal elevated levels of copper. Which of the following clinical manifestations would the physician most expect to see in this patient?