Chem Path - Renal

Question 1

Three days after admission to hospital with dementia, biochemical analysis of a patient’s serum reveals: urea 9.6 mmol/L, creatinine 90 μmol/L, calcium 2.70 mmol/L, phosphate 1.25 mmol/L and albumin 49 g/L. No biochemical abnormality had been present pre-admission. What is the most likely explanation for these results?

Question 1Select one:

a.
Acute phase response

b.
Dehydration

c.
Administration of parenteral feed with high amino acid content

d.
Acute tubular necrosis

e.
Primary hyperparathyroidism

Answer 1

Dehydration

Question 2

Which of the following suggests chronic rather than acute renal failure?

Question 2Select one:

a.
Normal sized kidneys on ultrasound

b.
Metabolic acidosis

c.
Microscopic haematuria

d.
Renal bone disease

e.
Nausea and vomiting

Answer 2

Renal bone disease

Question 3

A 56-year-old man with long standing poorly controlled diabetes mellitus visits his primary care physician for a follow up after recent hospitalisation. The patient experienced an episode of acute renal failure while in the hospital and his creatinine level rose to 350 mmol/l. Creatinine, a marker of renal function is produced from which of the following precursors?

Question 3Select one:

a.
Serine, Glycine and Methionine

b.
Glutamic acid, Cysteine and Glycine

c.
Glycine, Arginine and Methionine

d.
Glutamine, Cysteine and Glycine

e.
Glutamine, Aspartic acid and alanine

Answer 3

Glycine, Arginine and Methionine

Question 4

An 88-year-old man with dementia is admitted to hospital with increasing confusion. Blood tests are normal on admission.

Three days after admission to hospital, biochemical analysis shows (reference range in brackets):

Urea 11.8 mmol/L (2.4-7.5)

Creatinine 112 μmol/L (60-110)

Calcium (corrected) 2.70 mmol/L (2.15-2.55)

Phosphate 1.25 mmol/L (0.8-1.50)

Albumin 50 g/L (38-48)

What is the most likely explanation for these results?

Question 4Select one:

a.
Acute tubular necrosis

b.
Primary hyperparathyroidism

c.
Dehydration

d.
Acute phase response

e.
Administration of parenteral feed with high amino acid content

Answer 4

Dehydration

Question 5

A 61 year old diabetic man has an albumin-creatinine ratio (ACR) of113 (n<30). This means his urine contains too much:

Question 5Select one or more:

a.
Sodium

b.
Haemoglobin

c.
Protein

d.
Glucose

e.
Potassium

Answer 5

Protein

Question 6

A patient becomes severely dehydrated in a marathon. She is rehydrated, but is not passing much urine. You suspect she has acute kidney injury because:

Question 6Select one or more:

a.
A urine sample contains 2+ red cells.

b.
Her serum creatinine is now 170, baseline 3 weeks ago was 90.

c.
The albumin creatinine ratio is 103 (n<30)

d.
Her urine output is < 3 ml/kg per hour for 3 hours.

Answer 6

Her serum creatinine is now 170, baseline 3 weeks ago was 90.

Question 7

Joe is a healthy 25-year-old with no kidney disease. You would expect his eGFR to be:

Question 7Select one or more:

a.
>10

b.
>70

c.
>50

d.
>30

e.
>90

Answer 7

> 90

Question 8

Which of the following is a recognised feature of acute kidney injury in previously healthy individuals?

Question 8Select one or more:

a.
Decreased kidney size

b.
Polycythemia

c.
Metabolic alkalosis

d.
Hyperkalaemia

e.
Increased glomerular filtration rate

Answer 8

Hyperkalaemia