Nephrology Quiz

A 34-year-old diabetic patient is admitted with a creatinine level of 5 mg/dL. His urine analysis shows 4+ proteinuria, with occasional red blood cells, and a urine protein-to-creatinine ratio (PCR) of 8 grams. The next day, his creatinine rises to 6.5 mg/dL. Based on this presentation, which of the following is most likely?

• The patient has a rapidly progressive glomerulonephritis (RPGN) component.

• The patient has rapidly progressive renal failure (RPRF).

• The patient has both RPGN and RPRF.

• None of the above.

Answer explanation

Given the clinical details provided, the best interpretation would be that the patient has features of rapidly progressive renal failure (RPRF), which is suggested by the following:

●     A significant increase in creatinine from 5 to 6.5 within a short period.

●     Severe proteinuria (4+ and 8 grams on urine PCR), suggesting significant kidney damage.

●     Absence of hematuria or red cells in the urine analysis, which makes RPGN (Rapidly Progressive Glomerulonephritis) less likely, as this condition often presents with hematuria and casts.

Answer: Second answer – The patient has got RPRF.

While RPGN could be a possibility, the absence of hematuria, the rapid progression of renal failure, and the underlying diabetic nephropathy with significant proteinuria point toward RPRF

What is the role of Lasix (furosemide) in the management of acute kidney injury (AKI)?

• If the patient has developed fluid overload or pulmonary edema.

• If the patient's urine output is oliguric to improve urine output.

• For the prevention of AKI.

• For all of the above.

Answer explanation

The correct answer is:

1. If the patient has developed fluid overload or pulmonary edema.

Lasix (furosemide) is a loop diuretic commonly used in acute kidney injury (AKI) for managing fluid overload or pulmonary edema, particularly when there is a need to reduce excess fluid that the kidneys are unable to excrete.

●     Option 2 is not entirely correct because while Lasix can increase urine output in cases of oliguric AKI, it does not necessarily improve renal function or recovery in AKI.

●     Option 3 is incorrect as Lasix is not used for preventing AKI.

●     Option 4 is not appropriate because Lasix is not used in all of these situations for AKI management.

 

In medicine, what is considered most important?

• Knowing what we don't know.

• Trying to know what we don't know.

• What we don't know, we don't know.

• All of the above.

A 45-year-old male patient is admitted with a 3-day history of fever, severe cough, and pleuritic chest pain. On examination, right lower zone (RLZ) bronchial breathing (BB) and crepitations are noted. A chest X-ray shows RLZ consolidation. He is started on IV Augmentin and clarithromycin. What is the appropriate term for this antibiotic treatment?

• Appropriate Antibiotic

• Empirical Antibiotic

• Rationalizing Antibiotic

• All of the above

Answer explanation

Correct Answer:
2. Empirical Antibiotic

Explanation:
The antibiotics are termed "empirical" as they are chosen based on clinical suspicion and common causative organisms for community-acquired pneumonia, without waiting for specific culture results.

When referring a patient to a nephrologist or the renal team, what are the basic requirements that should be fulfilled?

• Urine full report

• Ultrasound scan

• You do not need anything

• A minimum of both these investigations

When working in a resource-limited setting, what should you consider important to limit workload and improve the efficacy of patient management?

• Limiting the management of patients with poor prognosis

• Do not worry about prognosis; continue managing all patients

• Try to improve your resources

• Do not agree with any of the above

A middle-aged gentleman is admitted with severe septic shock. He is on inotropic support, but his blood pressure remains low at 70/50 mmHg. His creatinine is 12 mg/dL, he is anuric, his potassium is 4.5 mmol/L, and he has severe lactic acidosis. What would be your next appropriate course of action?

• Ensure that his mean arterial blood pressure is optimized to perfuse the kidneys

• Contact the renal team for urgent dialysis

• Administer more fluids

• Consider other supportive measures

A CKD stage 5 patient comes for a routine clinic visit. He is peripherally edematous and on Lasix 80 mg twice daily. His oxygen saturation on air is 100%, and he does not exhibit dyspnea. What clinical features would you expect in this patient when assessing for volume overload?

• Right heart failure features

• Left heart failure features

• Both

• None of the above

How can auscultation of lung signs help differentiate between right and left heart failure?

• Presence of crackles in the lungs suggests left heart failure, while clear lung fields or reduced air entry are typical of right heart failure.

• Wheezing is a key feature of right heart failure, while crackles indicate left heart failure.

• Both right and left heart failure present with identical lung sounds.

• Auscultation of lung signs does not help differentiate between right and left heart failure.

What is more important when treating a patient?

• The way of their living

• The way of their dying

• Both of the above

• None of the above

Answer explanation

When death is imminent, the way of dying is important.