Introduction to Renal Quiz

A 6-year-old boy is brought to the office by his mother because his eyes are puffy in the morning and his feet are swollen in the afternoon. The mother states the boy recently recovered from an insect bite on the face 10 days ago. He has otherwise been well.

Vital signs are normal.

Physical examination shows pitting edema of the feet up to the lower legs. the exam is otherwise normal

Urinalysis:

• Hemoglobin: negative
• Protein: 4+
• Leukocyte esterase: negative
• Nitrites: negative
• Sediment: no casts seen

The diagnosis can best be made by

A 21-year-old female comes to her physician’s office because she has a burning sensation when urinating, and an urgent need to urinate often for the past 5 days. She has had several chills and feels quite unwell. She has developed a deep ache in her right lateral back. She denies a vaginal or urethral discharge. She takes an oral contraceptive and is sexually active with her boyfriend.

Vital signs: Temperature: 102.1 F; HR 101 /min; RR 14 /min; BP 112/74 mmHg; SpO2 97% on room air

Physical examination: Percussing over the right costovertebral angle elicits her back pain. There is suprapubic tenderness. Pelvic examination is unremarkable and there is no tenderness with cervical motion. The remainder of the examination is normal.

The test most likely to establish a specific diagnosis is

A 74-year-old male is brought to the ED by his daughter who states her father “may have had a stroke” in the past few days. He has renal failure and missed his dialysis appointment 2 days ago. When he did not answer her phone calls, the daughter went over to his apartment and found him confused and weak on his couch. She shares with the doctor that her father has Type 2 Diabetes mellitus, hypertension, and hyperlipidemia.

Vital signs: BP 154/93 mmHg; temperature 99.1 F, HR 96 /min, RR 14 /min; SpO2 95% on room air

Physical examination reveals a slight, elderly male. He is mildly disoriented by there are no localizing neurologic findings. Skin shows multiple petechia. There is a mild pericardial friction rub.

What lab values would be expected for this patient?

A 23-year-old female presents to her physician’s office concerned that it burns when she urinates and that she needs to urinate too often. She has developed lower abdominal pain. She is sexually active with multiple partners and her partners do not use condoms consistently. She has no vaginal discharge. Her last menstrual period was 2 weeks ago.

Vital signs:  temperature  98.9 F, HR 88 /min, RR 12 /min, BP 112/72 mmHg, SpO2 89% on room air.

Physical exam shows suprapubic tenderness but is negative for costovertebral angle tenderness. Pelvic exam is normal.

Urinalysis

• Hemoglobin: 2+
• Protein: 3+
• Leukocyte esterase: 3+
• Nitrites: 3+
• The most likely initial pathophysiology of this patient’s findings is

A 34-year-old male presents to ER after experiencing colicky pain in his right groin for the past 24 hours. He states that the pain began in his lower back 2 days ago but has now localized to his groin. The patient rates the pain 9/10.

When the ER ultrasound study is negative, a CT scan is ordered (seen in the image).

Analysis of the structure indicated by the arrow would be expected to show