Nephrology Quiz

A patient with a history of Sjögren syndrome has the following laboratory findings: plasma sodium 139 mEq/L, chloride 112 mEq/L, bicarbonate 15 mEq/L, and potassium 3.0 mEq/L. Urine studies show a pH of 6.0, sodium of 15 mEq/L, potassium of 10 mEq/L, and chloride of 12 mEq/L.
What is the most likely diagnosis?

• Chronic diarrhea
• Type I renal tubular acidosis (RTA)
• Type II RTA
• Type IV RTA

A patient is followed closely by her nephrologist for stage IV chronic kidney disease associated with focal segmental glomerulosclerosis.
Which of the following is an indication for initiation of maintenance hemodialysis?

• Creatinine >5 mg/dL without symptoms
• Acidosis controlled with daily bicarbonate administration
• Bleeding diathesis
• Hyperkalemia controlled with sodium polystyrene

A 35-year-old woman with hypertensive kidney disease progresses to end-stage renal disease. She was initiated on peritoneal dialysis 1 year ago and has done well with relief of her uremic symptoms. She is brought to the emergency department with fever, altered mental status, diffuse abdominal pain, and cloudy dialysate. Her peritoneal fluid is withdrawn through her catheter and sent to the laboratory for analysis. The fluid white blood cell count is 125/μL with 85% polymorphonuclear neutrophils.
Which organism is most likely to be found on culture of the peritoneal fluid?

• E coli
• Candida albicans
• Pseudomonas aeruginosa
• Staphylococcus epidermidis

At 25 year old man presents with a history of upper respiratory symptoms followed by streaky hemoptysis and malaise. His blood pressure was 140/90 and he has trace lower extremity edema. Pertinent laboratory include BUN 86 mg/dL & Cr of 3.5 mg/dL. Urinanalysis shows +2 protein, 3 blood, 5 to 10 RBC/hpf, and rare RBC cast. Chest radiograph demonstrates opacities in both lung fields.
The most likely diagnosis at this point:

• Wegener’s granulomatosis
• Anti-glomerular basement membrane disease
• Post-infectious glomerulonephritis
• Allergic interstitial nephritis

At 25 year old man presents with a history of upper respiratory symptoms followed by streaky hemoptysis and malaise. His blood pressure was 140/90 and he has trace lower extremity edema. Pertinent laboratory include BUN 86 mg/dL & Cr of 3.5 mg/dL. Urinanalysis shows +2 protein, 3 blood, 5 to 10 RBC/hpf, and rare RBC cast. Chest radiograph demonstrates opacities in both lung fields.
The most appropriate initial diagnostic study should be:

• Bronchoscopy with biopsy
• CT chest and abdomen
• Biopsy of the nasal mucosal
• Percutaneous renal biopsy with immunoflorescence microscopic examination

At 25 year old man presents with a history of upper respiratory symptoms followed by streaky hemoptysis and malaise. His blood pressure was 140/90 and he has trace lower extremity edema. Pertinent laboratory include BUN 86 mg/dL & Cr of 3.5 mg/dL. Urinanalysis shows +2 protein, 3 blood, 5 to 10 RBC/hpf, and rare RBC cast. Chest radiograph demonstrates opacities in both lung fields.
The clinical course of this lesion:

• Depends on how rapidly treatment is initiated
• Can be predicted by the amount of urine output
• Can be predicted by the serum creatinine concentration on presentation
• All of the above