PCRC - Renal/GU

A 25-year-old female comes with reports of a sudden onset of increased thirst and urination. This began abruptly 1 week ago and has not abated since. She states that since that time she has been thirsty all the time. The only significant illness in her life has been the recent diagnosis of bipolar affective illness , and she was started on lithium carbonate and is currently taking 1200 mg/day. Her serum lithium levels have been normal since the beginning.Physical Examination On examination, her blood pressure is 110/70 mm Hg. She has lost 5 pounds during the last week and looks somewhat dehydrated. Laboratory Results Serum Na 155 mEq/LUrine glucose: neg Urine ketones: trace Urine Osmolality 250 mOsm/kg Urine Na 35 mEqWhat is the most likely diagnosis in this patient?

central diabetes insipidus
nephrogenic diabetes insipidus
type 1 diabetes mellitus
psychogenic polydipsia

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nephrogenic diabetes insipidus

Select the form of glomerular disease that is the most common cause of nephrotic syndrome in adult:

A. Membranoproliferative glomerulonephritis
B. Focal segmental glomerulonephritis
C. Membranous glomerulopathy
D. IgA nephropathy
E. Rapidly progressive glomerulonephritis

C. Membranous glomerulopathy

Staghorn calculi are composed of:

A. Calcium oxalate
B. Calcium phosphate
C. Uric acid
D. Cystine
E. Magnesium ammonium phosphate

E. Magnesium ammonium phosphate

The most common complication of peritoneal dialysis for chronic renal failure is:

A. inability to perform renal transplantation
B. bacterial peritonitis
C. leakage of fluid around catheter exit site
D. internal stenosis of the peritoneal catheter
E. development of abdominal adhesions that produce decreased surface area for clearance

B. bacterial peritonitis

The most important risk factor for testicular carcinoma is:

A. maternal estrogen exposure
B. cryptorchidism (undescended testicles)
C. radiation exposure
D. mumps

cryptorchidism (undescended testicles

A 36 year-old Asian man with a history of asthma presents with a complaint of red urine. He describes 5 days of nasal congestion and dry cough. He notes no sore throat, fever, chills, myalgias, arthralgias, or flank pain. There is no family history of renal disease. Urinalysis shows 1+ protein with 30-50 RBC but no WBC. The same symptom complex occurred 6 months and twelve months earlier. CBC and peripheral blood smear is normal. His serum creatinine is normal. Which one of the following is the most likely diagnosis?

A. Post-streptococcal glomerulonephritis
B. Transitional cell carcinoma of the bladder
C. IgA nephropathy
D. Hemolytic uremic syndrome
E. Nephrolithiasis

C. IgA nephropathy

A 62 y/o diabetic male underwent an abdominal aortic aneurysm repair 2 days ago. He is being treated with gentamicin for a UTI. His urine output has fallen to 300 mL/24 hours, and his serum creatinine has risen from 1.1 (admission) to 1.9 mg/dL. Which of the following laboratory results or physical examination findings would be most consistent with a prerenal etiology of his renal insufficiency?

A. Urinary sodium of 8 mEq/L
B. CVP 12 mm Hg
C. Fractional Excretion of sodium 3%
D. Gentamicin trough level of 4 mcg/mL

A. Urinary sodium of 8 mEq/L

A 25-year-old woman has been hospitalized for treatment of a Staphylococcus aureus abscess of her left thigh complicating a puncture wound. The wound is incised and drained and she receives antibiotic therapy. She is improving and discharged home a week later, but the next day she develops a fever. On physical examination her temperature is 38.1 C and there is a diffuse erythematous skin rash of her trunk and extremities. A urinalysis shows sp gr 1.020, pH 6.5, 1+ blood, 1+ protein, no glucose, and no ketones. There are 10-20 WBCs/hpf and 1-5 RBCs/hpf, and a few eosinophils are noted on urine microscopic examination. Which of the following is the most likely diagnosis?

Acute tubular necrosis
Drug-induced interstitial nephritis
Urinary tract infection
Myoglobinura

Drug-induced interstitial nephritis

A 23-year-old African American man with AIDS is sent for workup of nephrotic syndrome. His BP is 140/82 mm Hg. He has 3+ edema in both legs. His risk factor for AIDS is IV heroin use. His creatinine is 2.0 and urine reveals 3+ protein, no blood. A kidney biopsy would most likely reveal which of the following?

Heymann antigen
Nil disease
Focal glomerular sclerosis
Membranous nephropathy
IgA nephropathy

Membranous nephropathy

A 64 y/o Caucasian male with a history of hypertension, hyperlipidemia, and nephrolithiasis presents with a complaint of dark-colored urine. He has been taking Mevacor (lovastatin) for elevated cholesterol. He felt well until 2 days ago when he noted increasing fatigue and muscle weakness. Dipstick urinalysis shows a specific gravity of 1.020, no protein and large blood. The urine sediment reveals no RBC or WBC. Serum creatinine is elevated to 3.5 mg/dL. Which of the following diagnostic procedures is appropriate at this point?

A. Serum analysis to determine the level of creatine phosphokinase (CPK)
B. Kidney biopsy to delineate the disease process
C. Cystoscopy to evaluate for urologic cancer
D. Flank computed tomography (CT) to evaluate for recurrent nephrolithiasis

A. Serum analysis to determine the level of creatine phosphokinase (CPK)