NephrologyClinicalProblems

Hematuria1. Atenyearoldboycomplainsofdarkurineandaheadache.
Proteinuria
Discussyourdiagnosticapproachtothispatient.
Mentionthemostprobablediagnosis,management,
treatment
andpatienteducation.

2. A fouryear old patient complains of increased weight gain,

swollen
eyes,handsandfeet.MotherrefersarecentURI.

Discussyourdiagnosticapproachtothispatient.
Mentionthedifferentialdiagnosis.
Mentionyourmanagementandtreatment.

3.A5yearoldpresentsproteinuriaonaroutineurineanalysis.

Discussyourdiagnosticapproachtothispatient.
Mentionthedifferentialdiagnosis.
Mentionyourmanagement.

FORMATIVEEXAM

NEPHROLOGY

1. Approximateelectrolyteconcentrationforthesolutiontobegiventoawellhydrated
patienttocoverforthedailymaintenancerequirements:

Na+
K+
a.
0
0
b.150
0
c.3040
20
d.5090
20
e.300
20

2. The edema, heart failure, pulmonary edema and hypertension in acute post
streptococcalglomerulonephritisisprimarilycausedby:

a.systemicvasculitiswhichincludesthelungsandtheheart
b.streptococcalmyocarditisandpneumonitis
c.saltandwaterretentionduetotheacuteglomerulussfailure
d.hyperkalemiaduetotheacuteglomerulussfailure
e.waterretentionasacompensatorymechanismfortheproteinuria
andhypoalbuminemia

3. The following are considered appropriate therapy for patients in acute renal failure
duetopoststreptococcalglomerulonephritisexceptfor:

a.
use of vasodilators such as serpasil and apresoline in patients with
hypertensionbutwithoutencephalopathy
b. admission to the intensive care unit for an emergency intravenous
antihypertensive
therapyofrapideffect(ex. diazoxide hyperstat) in patients with
earlysignsof
encephalopathy.
c.
admission to the intensive care unit for instituting a rapid
digitalizationregimeandintravenoussteroidtherapy
d. use of potassium, protein and sodium free sugar oral solution at
least for the first 24 hours of therapy in patients with severe
oliguria
e.
the administration of penicillin in patients with Group Abeta
hemolyticstreptococcipositivethroatandimpetigolesionscultures

(Cont.)

4. A well developed and nourished 6year old boy is admitted with history of severe
abdominal pain and vomiting. There are purpuric lesions in the extensor surface of lower
extremities. The left ankle and right knee is swollen and painful. The blood pressure is
elevated and the urine reveals red blood cell casts. The platelet count is normal. The
abdominal radiologic studies reveal findings compatible with intussusceptions. The most
likelydiagnosisis:

a.acutepoststreptococcalglomerulonephritis
b.HenochSchonleinsyndrome
c.batteredchildsyndrome
d.generalizedintravascularcoagulopathy
e.meningococcalsepticemia

5. Themostimportantcauseofacidosisinchronicrenalinsufficiencyis:

a
ketosis
b: sulfateandphosphateretention
c. hypertension
d. hypoxemia
e. respiratoryretentionOfCO2

6. A 2year old presents a blood pressure of 150/90mmHg(rightarm)160/90(rightleg).He

has ahistoryofdiarrheaof5monthsduration.Urinerevealshematuria.Anabdominalmass
isfeltonexaminationoftheabdomen:
a. acutehypertensivecrisisinacuteglomerulonephritis
immediateI.V.administrationofapotent
antihypertensiveagentisindicated
b. hypertensionsecondarytoacongenitalcardiovascular
anomalysurgicalcorrectionisindicated
c. hypertensionissecondarytoincreasedintracranial
pressureandimmediatemeasuresshouldbetakento
reducetheintracranialpressure
d. hypertensionissecondarytoacatecholamine
producingtumor,surgeryisindicated
e. noneofthese

Match.78
A.Chronicrenalfailurerickets
B.VitDdeficiencyrickets
C.Both
E.Neither

_____7.
Thereisdiminishedformationof125(OH)2VitP)andhyperphosphatemia.

_____8.
Associated with celiac, fibrocystic disease, tropical sprue and anticonvulsive
therapy.


(Cont.)
Match.

_____9.WaterreabsorptionoccursADHisrequired.

_____10. Theantigenantibodycomplexesresultingfromstreptococcalinfection
willproduce
damagetothissite.