A 62-year-old man has had back pain for the past 8 months. He has had a productive cough for the past 2 days. On physical examination his temperature is 39°C and there is dullness to percussion at the right lung base. Laboratory studies show 4+ gram-positive diplococci in the sputum. A chest radiograph shows right lower lobe consolidation. An abdominal CT scan shows multiple lytic lesions of the vertebrae. On the day prior to death his serum urea nitrogen was 63 mg/dL with creatinine 7.1 mg/dL. A dipstick urinalysis was normal. At autopsy, his kidneys are firm and pale. Microscopically, there is abundant pink hyaline material in glomeruli and around small vessels. This material stains positively with Congo red. Which of the following laboratory findings was most likely to have been present in this patient in the week prior to death?

A 52-year-old previously healthy man has experienced episodes of discomfort with urination for 3 months. There are no remarkable findings on physical examination. Laboratory studies include a urinalysis that reveals 1+ blood. Microscopic urine examination shows numerous RBCs, a few WBCs, and no casts. A urine culture is negative. A plain film radiograph of the pelvis shows a rounded, 1 cm radiopaque lesion in the region of the bladder. Which of the following laboratory test findings is most likely to be present in this man?

A 72-year-old man has been feeling tired and lethargic for 5 months. He has noted increasing hesitancy with urination. On physical examination his prostate is diffusely enlarged. Laboratory studies show sodium 139 mmol/L, potassium 4.0 mmol/L, chloride 104 mmol/L, CO2 25 mmol/L, creatinine 1.9 mg/dL, and glucose 81 mg/dL. Which of the following renal abnormalities is most likely to be present in this man?

A 36-year-old woman has urinary frequency with dysuria for the past 4 days. On physical examination she has no flank pain or tenderness. A urinalysis reveals sp. gr. 1.014, pH 7.5, no glucose, no protein, no blood, nitrite positive, and many WBC's. She has a serum creatinine of 0.9 mg/dL. Which of the following is the most likely diagnosis?

A 69-year-old man incurs blunt force trauma from a fall. On physical examination he has a contusion on his lower back. An abdominal CT scan shows 3 peripheral 1 to 2 cm cysts in his kidneys. The kidneys are normal in size. Laboratory studies show a serum urea nitrogen of 16 mg/dL and creatinine of 1.1 mg/dL. A urinalysis reveals no blood, ketones, protein, or glucose. Microscopic urinalysis reveals a few oxalate crystals. Which of the following is the most likely diagnosis?

A clinical study is performed with pediatric subjects who had a diagnosis of minimal change disease. These patients were observed to have prominent periorbital edema at diagnosis. Laboratory test findings from serum and urine tests were analyzed. Which of the following urinalysis test findings is most likely to have been consistently present in these subjects?.

A 12-year-old boy is a member of a family with a history of renal disease, with males more severely affected than females. He is found to have auditory nerve deafness, corneal dystrophy, and ocular lens dislocation. A urinalysis shows microscopic hematuria. A renal biopsy is performed. Microscopically, the glomeruli show glomerular capillaries with irregular basement membrane thickening and attenuation with splitting of the lamina densa. The mesangial matrix is increased and epithelial cells may appear foamy. Which of the following is the most likely diagnosis?

A clinical study is performed of laboratory findings in subjects with renal diseases. Loss of physiologic function accompanies many diseases. One renal physiologic function affects thirst. Loss of which of the following renal functions is most likely to be identified by laboratory measurement of the urine specific gravity following water deprivation?

A 45-year-old woman has had increasing malaise for the past year. On physical examination her blood pressure is 265/150 mm Hg. Laboratory studies show a plasma renin activity of 9 ng/mL/hr. She then suffers a 'stroke' with a right basal ganglia hemorrhage and dies. At autopsy the kidneys are bilaterally small with granular surfaces. Microscopically they show hyperplastic arteriolosclerosis with fibrinoid necrosis, petechial hemorrhages, and microinfarcts in the cortices. Which of the following conditions is most likely to be her underlying cause of death?

A 3-year-old child has become more irritable over the past two months and does not want to eat much at meals. On physical examination the pediatrician notes an enlarged abdomen and can palpate a mass on the right. An abdominal CT scan reveals a 10 cm solid mass involving the right kidney. The resected mass has a microscopic appearance with sheets of small blue cells along with primitive tubular structures. The child receives chemotherapy and radiation therapy, and there is no recurrence. Which of the following neoplasms is this child most likely to have had?

A 5-year-old boy is noted to have increased puffiness around his eyes for the past week, and he has been less active than normal. On physical examination he has periorbital edema. Vital signs include T 37°C, P 75/minute, RR 22/minute, and BP 140/90 mm Hg. A urinalysis reveals sp. gr. 1.010, pH 6.5, no glucose, 4+ protein, no blood, no casts, and no ketones. Microscopic urinalysis reveals oval fat bodies, but no WBC's or RBC's. He improves following a course of corticosteroid therapy. Which of the following renal lesions is most likely to have been present in this boy?

A clinical study is performed involving subjects with glomerulonephritis. One group of subjects has a diagnosis of crescentic glomerulonephritis and another group has membranous nephropathy. Which one of the following laboratory findings is most likely to be found in the absence of other findings in subjects with membranous nephropathy?

A 51-year-old man is hospitalized for acute myocardial infarction. He has decreased cardiac output with hypotension requiring multiple pressor agents. His urine output drops over the next 3 days. His serum urea nitrogen increases to 59 mg/dL, with creatinine of 2.9 mg/dL. Urinalysis reveals no protein or glucose, a trace blood, and numerous hyaline casts. Five days later, he develops polyuria and his serum urea nitrogen declines. Which of the following pathologic findings in his kidneys is most likely to have caused his azotemia?

A clinical study is performed to determine the value of percutaneous renal biopsy. The medical records of subjects with renal diseases are analyzed to note the circumstances in which the results of a renal biopsy facilitated choice of therapy that improved prognosis. In which of the following situations is a percutaneous needle biopsy of the kidney most useful?

A 56-year-old man complains of dull flank pain for the past month. On physical examination he has tenderness to percussion at the right costovertebral angle. Laboratory studies show microscopic hematuria but no proteinuria or glucosuria. A urine cytology shows no atypical cells. A CBC shows WBC count 7800/microliter, Hgb 21.1 g/dL, Hct 63.5%, MCV 94 fL, and platelet count 195,000/microliter. His serum urea nitrogen is 15 mg/dL and creatinine 1 mg/dL. Which of the following radiographic findings is most likely to be present in this man?

A 43-year-old man goes to his physician for a routine check of his health status. He is found to have a blood pressure of 150/95 mm Hg. His urinalysis shows pH 6.5, specific gravity 1.015, no glucose, blood, or protein, and no casts. His serum creatinine is 1.4 mg/dL. If he is not treated, which of the following conditions will most likely cause his death?

A 20-year-old previously healthy man has been feeling tired for the past 5 days. He then passes dark-colored urine. On physical examination his blood pressure is 160/90 mm Hg. Laboratory studies show his serum creatinine is 4.4 mg/dL and BUN 40 mg/dL. A urinalysis reveals pH 6, specific gravity 1.011, 3+ blood, 1+ protein, no glucose, and no ketones. On urine microscopic examination there are numerous RBC casts. Which of the following pathologic findings on renal biopsy is most likely to be present in this man?

A 43-year-old man has had increasing malaise for the past 3 weeks. On physical examination he has a blood pressure of 150/95 mm Hg and 1+ pitting edema of the lower extremities to the knees. Dipstick urinalysis shows no glucose, blood, ketones, nitrite, or urobilinogen, and the microscopic urinalysis reveals no RBC/hpf and only 1 WBC/hpf. Additional laboratory studies show a 24 hour urine protein of 4.1 gm. His serum creatinine is 3.5 mg/dL with urea nitrogen of 38 mg/dL. His hepatitis B surface antigen is positive. Which of the following is the most likely diagnosis?

A 60-year-old woman is admitted with sudden onset of chest pain and is diagnosed with an acute myocardial infarction. There is difficulty maintaining adequate blood pressure and tissue perfusion for 3 days. Her serum lactate becomes elevated. Her serum urea nitrogen increases to 44 mg/dL and creatinine to 2.2 mg/dL. Granular and hyaline casts are present on microscopic urinalysis. Which of the following renal lesions is most likely to be present in this situation?

A 50-year-old man was diagnosed at age 15 with type 1 diabetes mellitus. His disease has been poorly controlled, as evidenced by elevated hemoglobin A1C levels. He develops a non-healing ulcer of his foot at age 35. At age 45, he has an increasing serum urea nitrogen and a urinalysis shows sp gr 1.012, pH 6.5, 1+ protein, no blood, 1+ glucose, negative leukocyte esterase, negative nitrite, and no ketones. Which of the following renal diseases is he most likely to have?

A 39-year-old woman is found to have a blood pressure of 160/105 mm Hg while at a free health screening clinic. She feels fine and has had no major medical problems in her life. An abdominal ultrasound reveals that the left kidney is smaller than the right, but that neither is cystic and no masses appear to be present. MR angiography reveals focal narrowing with thickening and beading of the left main renal artery. A urinalysis reveals no abnormal findings. She has an elevated plasma renin. Which of the following is the most likely diagnosis?

A 70-year-old woman has had a fever for the past 3 days. She has burning dysuria. On physical examination her temperature is 37.8°C and there is dull pain on palpation of her left lower back. Laboratory studies show Hgb 13.3 g/dL, Hct 40.2%, and WBC count 12,300/microliter with differential count 72 segs, 9 bands, 13 lymphs, 5 monos, and 1 eosinophil. A urine dipstick analysis shows sp gr. 1.017, pH 6, leukocyte esterase positive, nitrite positive, protein negative, glucose negative, and blood negative. Which of the following microscopic urinalysis findings would be most diagnostic for her renal disease?

A 53-year-old woman has had chronic arthritis pain for the past 3 years. She has taken 2 gm of phenacetin and acetaminophen a day for her pain over that time. She now has increasing fatigue. There are no abnormal findings on physical examination. Laboratory studies show her serum urea nitrogen is 52 mg/dL and creatinine 5.4 mg/dL. Which of the following pathologic findings is most likely to occur in her kidneys?

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?

A 39-year-old previously healthy man has the sudden onset of severe right flank pain that comes in waves all night long. When he is seen in the emergency room, after waiting for two hours, he is exhausted. On physical examination there are no abnormal findings. Urinalysis reveals no ketones, glucose, protein, nitrite, or urobilinogen, but blood is present. Urine microscopic examination shows many RBCs but few WBCs. The specific gravity is 1.015 and the pH is 5.5. Which of the following is the most likely diagnosis?

A 15-year-old girl has had increasing lethargy following a bout of the 'flu' 3 weeks ago. On physical examination there are no abnormal findings. Her condition does not improve after 3 weeks on corticosteroid therapy, so a renal biopsy is performed and microscopic examination shows segmental sclerosis of 3 of 10 glomeruli. Immunofluorescence studies and electron microscopy do not show immune deposits. Which of the following is the most likely outcome for this girl's condition?

A 59-year-old man notes blood in his urine for the past week. On physical examination there are no abnormal findings. A urinalysis confirms the presence of blood, but no proteinuria or glucosuria. A urine culture is negative. A cystoscopy is performed, and a 3 cm exophytic mass is seen in the dome of the bladder. A biopsy of this mass is performed and microscopic examination reveals fibrovascular cores covered by a thick layer of transitional cells. Which of the following risk factors is most likely to have led to development of this lesion?

A 53-year-old woman has noted fever and right-sided flank pain for the past 3 days. On physical examination her temperature is 38.4°C and there is right costovertebral angle tenderness. A urinalysis reveals sp. gr. 1.010, pH 7.5, no glucose, no protein, no ketones, and 1+ blood. Many WBCs and WBC casts are seen on urine microscopic examination. An abdominal radiograph reveals a radiopaque calculus that forms a cast of a dilated right renal collecting system. A urine culture grows Proteus vulgaris. Which of the following crystals is most likely to be seen in large numbers on microscopic urinalysis in this woman?

A 60-year-old man was diagnosed last year with adenocarcinoma of the lung, and he underwent right lower lobectomy. For the past 3 weeks he has had increasing malaise. On physical examination he has pitting edema to his knees and presacral edema. Abdominal and chest CT scans show scattered hepatic mass lesions and hilar lymphadenopathy. A urinalysis reveals 4+ proteinuria, and his 24 hour urine protein is 2.7 gm. His serum urea nitrogen is 55 mg/dL with creatinine of 6.1 mg/dL. A renal biopsy is performed, and there is focal deposition of IgG and C3 with a granular pattern. Which of the following forms of glomerular disease is he most likely to have?

A clinical study is performed with subjects born with congenital urinary tract anomalies. Their records are reviewed to assess the development of long term complications. One group of subjects is found to have an increased risk for both infection and development of a carcinoma. Which of the following congenital urinary tract anomalies is most likely to carry this risk?

A 57-year-old man has had dysuria for the past week. Over the past 2 days he has experienced shaking chills. On physical examination his temperature is 39.3°C. A urinalysis shows sp gr 1.016, pH 6, 1+ glucose, 1+ blood, no ketones, and no protein. Urine microscopic examination shows numerous WBCs and WBC casts. His serum creatinine is 1.5 mg/dL and glucose 155 mg/dL with hemoglobin A1C 8.7%. A renal ultrasound scan shows a 0.3 cm free floating echodense object in the left renal pelvis. Which of the following complications has this man most likely developed?

A 48-year-old woman has had increasing malaise for the past 6 months. On physical examination there are no abnormal findings except for diminished sensation to pinprick and light touch in her lower legs and feet. She is afebrile and normotensive. Laboratory studies show serum creatinine 4.5 mg/dL, urea nitrogen 42 mg/dL, glucose 130 mg/dL, and hemoglobin A1C 7.9%. A urinalysis shows 1+ glucose, 1+ protein, no blood, and no ketones. Urine microscopic examination shows 1 RBC/hpf and 1 WBC/hpf. Which of the following pathologic abnormalities is she most likely to have in her kidneys?

A 25-year-old G3 P2 woman has felt no fetal movement by 18 weeks gestation. Fetal ultrasound scan reveals the lack of amniotic fluid, making imaging difficult, but bilaterally asymmetrically enlarged fetal kidneys are seen. No fetal bladder can be visualized. The fetal heart appears to have four chambers, and the feet have marked varus deformities. At the time of birth at 36 weeks gestation, the neonate has severe respiratory difficulty. Which of the following is the most likely diagnosis?

A 49-year-old woman has been hospitalized for the past 10 days for treatment of bronchopneumonia. She has developed chills and fever over the past 2 days. On physical examination her temperature is 38.8°C and she has a diffuse erythematous skin rash. Laboratory studies show serum creatinine 2.2 mg/dL and glucose 73 mg/dL. A peripheral blood smear reveals eosinophilia. On urinalysis she has 2+ proteinuria but no blood, glucose, or ketones. Which of the following is the most likely diagnosis?

A clinical study is performed with subjects diagnosed with hypertension who underwent an extensive workup to determine possible treatable causes for their hypertension. It is observed that some causes for hypertension are surgically correctable, while other causes are amenable to pharmacologic therapy. Laboratory findings in the subjects are analyzed. Which of the following laboratory test findings is most likely to be present in subjects with hypertension treated by drugs, rather than by surgery?

A 30-year-old man has had increasing malaise with fever, abdominal pain, and weight loss of 3 kg over the past 3 weeks. On physical examination his blood pressure is 165/110 mm Hg. He has a stool positive for occult blood. A urinalysis reveals hematuria but no proteinuria or glucosuria. He has no serum anti-neutrophil cytoplasmic autoantibodies and his antinuclear antibody test is negative. Aneurysmal arterial dilations and occlusions are seen in the medium sized renal and mesenteric arteries with angiography. He improves with corticosteroid therapy. Which of the following is the most likely diagnosis?

A young, sexually active man has a two day history of burning pain with urination. Physical examination reveals no penile lesions. A urinalysis reveals no blood, glucose, protein, or ketones, but the leukocyte esterase is positive. Urine microscopic examination shows 50 WBCs/hpf. A culture of penile secretions is negative for Neisseria gonorrheae. Which of the following infectious agents is most likely to cause his disease?

A 59-year-old man has experienced lower back pain for 4 months. On physical examination there are no abnormal findings. A urinalysis shows microscopic hematuria, but no proteinuria or glucosuria. An abdominal CT scan reveals a 6 cm solid mass in the upper pole of the right kidney. A right nephrectomy is performed, and the grossly variegated mass is seen microscopically to be composed of nests of cells with clear cytoplasm. Which of the following laboratory test findings likely to be associated with this lesion?

A 30-year-old man has noted puffiness around his eyes and swelling of his feet for the past 2 weeks. On physical examination his blood pressure is 155/95 mm Hg. Urine microscopic examination reveals oval fat bodies. Which of the following conditions is he most likely to have?

An 18-year-old primigravida has noted minimal fetal movement during pregnancy. She gives birth at 30 weeks gestation to a 2000 gm girl infant with Apgar scores of 4 and 5 at 1 and 5 minutes. The baby dies from respiratory distress within an hour of birth. At autopsy, the kidneys are markedly enlarged bilaterally. Microscopically, the renal parenchyma is replaced by numerous small radially arranged cysts. These findings are most likely to be seen in association with which of the following pathologic conditions?

A 55-year-old man is found down and unconscious. On physical examination he is afebrile. After catheterization, he passes a small amount of dark urine. The urine dipstick test for blood is positive but no red blood cells are seen on microscopic examination of the urine sediment. Which of the following is the most likely diagnosis?

A 5-year-old child has been noted by his mother to be lethargic for 2 weeks. On physical examination he has periorbital edema. He is afebrile. Dipstick urinalysis reveals no glucose, ketones, or blood, but he has 4+ proteinuria present. Microscopic urinalysis reveals no casts, but oval fat bodies are seen. He is treated with corticosteroid therapy and his condition improves. Which of the following renal electron micrographic findings is most characteristic for this child's disease?

A 70-year-old man has noted passing darker urine for the past week. On physical examination he has vital signs with T 37.1°C, P 73/minute, RR 16/minute, and BP 130/80 mm Hg. Laboratory studies include urinalysis with sp gr 1.015, pH 7, 2+ blood, no glucose, no protein, and no ketones. Urine microscopic examination shows 10 to 15 RBC/hpf and no WBCs, casts, or crystals. Cystoscopy is performed and no lesions are noted. Intravenous urography shows a 2 cm filling defect in the left renal pelvis. Which of the following laboratory test findings is most likely to be present in this man?

An 11-year-old girl has increasing lethargy and has passed dark-coloured urine for the past week. She had a sore throat two weeks ago. On physical examination she is afebrile with blood pressure 140/90 mm Hg. Laboratory studies show her serum creatinine is 2.8 mg/dL and urea nitrogen 24 mg/dL. Urinalysis shows 2+ blood, 2+ protein, no glucose, and no ketones. Microscopic urinalysis shows dysmorphic RBC's. A renal biopsy is performed and on microscopic examination shows glomerular hypercellularity, with PMNs present. Electron microscopy shows subepithelial electron dense 'humps'. Which of the following laboratory test findings is most likely to be present in this girl?