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Select the ONE answer that is BEST in each case.
A 25-year-old woman presents with nausea and vomiting of 2 days duration. She is not on any medications and was previously well until now. Her physical examination is normal except for a postural drop in her blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the following electrolytes is most likely to be filtered through the glomerulus but unaffected by tubular secretion?
Urea is filtered at the glomerulus, and thereafter, any movement in or out of tubules is a passive process depending on gradients, not secretion. Reabsorption of urea in the distal tubule and collecting duct, when urine flow is reduced, results in the disproportionate elevation of urea nitrogen over creatinine in prerenal azotemia.
See all quizzes of the Kidneys diseases at here:
|1. A 25-year-old woman presents with nausea and vomiting of 2 days duration. She is not on any medications and was previously well until now. Her physical examination is normal except for a postural drop in her blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the following electrolytes is most likely to be filtered through the glomerulus but unaffected by tubular secretion?
|2. Ten days after a kidney transplant, a 32-yearold man develops allograft enlargement, fever, oliguria, and hypertension. Which of the following is the most likely diagnosis?
(A) steroid hyperglycemia
(C) hyperacute rejection
(D) acute rejection
(E) renal artery stenosis
|3. A 19-year-old man presents with malaise, nausea, and decreased urine output. He was previously well, and his physical examination is normal except for an elevated jugular venous pressure (JVP) and a pericardial rub. His electrolytes reveal acute renal failure (ARF). Which of the following findings on the urinalysis is most likely in keeping with acute glomerulonephritis (GN)?
|4. A 24-year-old woman presents with nausea, vomiting, anorexia, and gross hematuria. She had a sore throat 2 weeks ago that resolved on its own. On examination, her blood pressure is 160/90 mm Hg, pulse 90/min, JVP is 7 cm, heart sounds are normal, there is 1+ pedal edema, and the lungs are clear. She has a renal biopsy. Which of the following electron microscopy findings on the renal biopsy is most likely in keeping with poststreptococcal GN?
(A) diffuse mesangial deposits
(B) no deposits
(C) electron-dense endothelial deposits
(D) closed capillary lumen
(E) subepithelial humps
|5. A 74-year-old man is brought to hospital because of urinary retention. He has a Foley catheter inserted to relieve the obstruction, and 1500 cc of urine is emptied from his bladder. Over the next few hours, he has 200cc/h of urine output. Which of the following urine electrolyte values is most likely in keeping with his diagnosis?
(A) high sodium
(B) low potassium
(C) high specific gravity
(D) low pH
(E) osmolality >500 mOsm/kg
|6. A 68-year-old woman has used large amounts of analgesic for years to relieve severe headaches and arthritis. She now has an elevated urea and creatinine consistent with chronic renal failure. Which of the following changes in the kidney is most likely seen with her diagnosis?
(B) papillary necrosis and tubulointerstitial inflammation
(C) cortical necrosis
(D) tubular necrosis
|7. A 64-year-old woman develops severe diarrhea 2 weeks after finishing antibiotics for pneumonia. She has also noticed decreased urine output despite drinking lots of fluids. On examination, she has a postural drop in her blood pressure, the JVP is low, and the abdomen is soft but diffusely tender. Despite giving 4 L of normal saline, her urine output remains low. The urinalysis is positive for heme-granular casts and the urine sodium is 42 mEq/L. Which of the following medications should be held during the recovery phase of this woman’s ARF?
|8. A 64-year-old woman has metabolic alkalosis and the bicarbonate level is 34 mEq/L. Which of the following is the most likely cause?
(A) diuretic use
(C) mineralocorticoid deficiency
(E) angiotensin-converting enzyme (ACE)- inhibitor use
|9. A 32-year-old man with sickle cell anemia is seen for routine follow-up. He feels well at the present time, but in the past he has had many sickle cell crises, which have resulted in kidney injury. Which of the following renal abnormalities is most likely to be seen in him?
(A) inability to acidify the urine
(B) granular casts
(C) inability to concentrate the urine
(E) salt-losing state
|10. A 63-year-old man with an 8-year history of recurrent severe arthritis in his large toes has an elevated creatinine level. Which of the following mechanisms is the most likely explanation for his renal impairment?
(B) vascular injury
(C) uric acid kidney stones
(D) distal tubular atrophy
(E) renal parenchymal uric acid crystals
|11. A 67-year-old man presents with symptoms of renal colic. Plain x-rays of the abdomen reveal no obvious stone. An intravenous pyelogram (IVP) is ordered to confirm the clinical diagnosis. Which of the following coexisting medical conditions increases the risk of contrast-induced nephropathy?
(E) multiple myeloma
|12. A 64-year-old man presents with weight gain, shortness of breath, easy bruising, and leg swelling. On examination, his blood pressure is 140/80 mm Hg, pulse 100/min, JVP 4 cm, heart sounds normal, and lungs are clear. There is a 3+ pedal and some periorbital edema. Investigations include a normal chest x-ray (CXR), electrocardiogram (ECG) with low voltages, anemia, high urea and creatinine, and 4 g/day of protein in the urine. A renal biopsy, which shows nodular deposits that have an apple-green birefringence under polarized light when stained with Congo red. Which of the following is the most likely diagnosis?
(B) multiple myeloma
(C) diabetic nephropathy
(D) minimal change disease
(E) immunoglobulin A (IgA) nephropathy
|13. A 74-year-old man presents with fatigue, shortness of breath on exertion, and back and rib pain, which is made worse with movement. Investigations reveal he is anemic, calcium, urea, and creatinine are elevated. X-rays reveal multiple lytic lesions in the long bones and ribs, and protein electrophoresis is positive for an immunoglobulin G (IgG) paraprotein. Which of the following is the most likely mechanism for the renal injury?
(A) plasma cell infiltrates
(B) tubular damage by light chains
(C) glomerular injury
(D) vascular injury by light chains
(E) uric acid crystals
|14. A 77-year-old man with a mass in the lung develops asymptomatic hyponatremia. His JVP is 4 cm, heart sounds are normal, and the lungs are clear. The urine sodium is 64 mEq/L and osmolality 550 mOsm/kg. Which of the following is the most likely diagnosis?
(A) nephrotic syndrome
(B) syndrome of inappropriate antidiuretic hormone (SIADH) production
(C) renal metastases from lung cancer
|15. A 69-year-old man has lost a friend to prostate cancer, and would like to be evaluated for the disease. He has no urinary symptoms. Which of the following tests is most likely indicated to screen him for prostate cancer?
(A) prostate ultrasound
(B) digital rectal examination (DRE)
(C) DRE and prostate specific antigen (PSA)
(E) none of the above
|16. A 63-year-old woman has Type II diabetes mellitus, which is well-controlled. Her physical examination is positive for peripheral neuropathy in the feet and nonproliferative retinopathy. A urinalysis is positive for proteinuria. Which of the following treatments is most likely to attenuate the course of renal disease?
(A) calcium channel blockers
(B) ACE inhibitors
(C) hepatic hydroxymethylglutarylcoenzyme A (HMG-CoA) inhibitors
(D) dietary carbohydrate restriction
(E) weight reduction
|17. A 32-year-old man has trace proteinuria on dipstick urinalysis. A 24-hour urine collection reveals 380 mg/day of protein excretion in the urine. Which of the following statements concerning this degree of proteinuria is correct?
(A) rarely requires any investigation
(B) in systemic diseases, it has no prognostic values
(C) can be caused by fever
(D) is rarely reversible
(E) always caused by tubular defects
|18. A 56-year-old man is involved in a severe motor vehicle accident. He develops ARF after admission to hospital. One of the possibilities for his ARF is posttraumatic renal vein thrombosis. Which of the following findings is most likely to suggest renal vein thrombosis?
(A) white cell casts on urinalysis
(B) heme-granular casts
(C) heavy proteinuria
(D) urine supernatant pink and tests positive for heme
(E) specific gravity >1.020
|19. A 69-year-old woman presents with left flank pain and hematuria. Physical examination suggests a left-sided abdominal mass. Computerized tomography (CT) scan of the abdomen reveals a 5-cm mass in the left kidney. Which of the following laboratory abnormalities might also be present?
(E) high renin hypertension
|20. A 60-year-old woman with heart failure and normal renal function is started on furosemide (Lasix) 80 mg/day. She notices a good diuretic response every time she takes the medication. A few weeks later, she is feeling unwell because of fatigue and muscle weakness, but her heart failure symptoms are better. Which of the following is the most likely explanation for her muscle weakness?