Question Easy:
A 65-year-old man visits his GP with fatigue, oedema, and frothy urine. Routine investigations reveal significant proteinuria. Which condition is most likely responsible for his symptoms?
A) Renal artery stenosis
B) Nephrotic syndrome
C) Acute tubular necrosis
D) Polycystic kidney disease
E) Urinary tract infection
Question Medium:
A 56-year-old woman presents with recurrent urinary tract infections (UTIs). Imaging shows a staghorn calculus in the right kidney. What organism is most commonly associated with the formation of such calculi?
A) Escherichia coli
B) Proteus mirabilis
C) Klebsiella pneumoniae
D) Enterococcus faecalis
E) Pseudomonas aeruginosa
Question Hard:
A 28-year-old woman with a history of recurrent kidney stones has a metabolic workup revealing marked hypercalciuria but normal serum calcium and parathyroid hormone levels. Which of the following is the most appropriate initial management strategy to reduce stone formation?
A) Thiazide diuretics
B) Loop diuretics
C) Potassium citrate
D) Allopurinol
E) Increased water intake
Explanations & Answers:
Question Easy Answer: B) Nephrotic syndrome
Question Easy Explanation: Nephrotic syndrome is characterized by significant proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia. In adults, common causes include diabetes mellitus, minimal change disease, and membranous nephropathy. The presence of frothy urine and oedema combined with proteinuria makes nephrotic syndrome the most likely diagnosis.
Question Medium Answer: B) Proteus mirabilis
Question Medium Explanation: Staghorn calculi are commonly associated with urease-producing organisms such as Proteus mirabilis. These bacteria can split urea into ammonia, creating an alkaline environment conducive to the formation of struvite stones, often presenting as staghorn calculi.
Question Hard Answer: A) Thiazide diuretics
Question Hard Explanation: In cases of hypercalciuria without hypercalcaemia, thiazide diuretics are often used as they reduce urinary calcium excretion by promoting renal tubular calcium reabsorption. Increased water intake is always recommended to lower the risk of stone formation, but thiazides are a more direct treatment for hypercalciuria.
Medical fact of the day: The kidneys filter approximately 180 litres of blood per day, producing about 1.5 to 2 litres of urine daily in a healthy adult. This incredible filtration process helps maintain the body’s electrolyte balance and eliminate waste products. 🚰
Quote of the day: “Every challenge in healthcare is an opportunity to heal, learn, and grow. Your compassion makes the toughest moments a beacon of hope.” 🌟