Question Easy: A 24-year-old man presents with severe right-sided loin pain radiating to the groin, accompanied by nausea and vomiting. 🧑⚕️ His urine dipstick shows microscopic haematuria. What is the most likely diagnosis?
A) Pyelonephritis
B) Renal colic due to a kidney stone
C) Urinary tract infection
D) Bladder cancer
E) Acute glomerulonephritis
Question Medium: A 65-year-old woman with a history of hypertension and type 2 diabetes presents with fatigue, decreased urinary output, and pitting edema around her ankles. Recent blood tests show elevated creatinine and potassium levels but low sodium. What is the most likely cause of her renal impairment? 🩺
A) Acute tubular necrosis
B) Pre-renal acute kidney injury
C) Chronic kidney disease
D) Acute interstitial nephritis
E) Acute glomerulonephritis
Question Hard: A 45-year-old male patient presents with recurrent episodes of visible haematuria and flank pain. Investigations reveal a positive family history of kidney disease, and renal ultrasound shows multiple cysts in both kidneys. Genetic testing reveals a mutation in the PKD1 gene. What is the most likely diagnosis?
A) Medullary sponge kidney
B) Autosomal recessive polycystic kidney disease
C) Autosomal dominant polycystic kidney disease
D) Alport syndrome
E) Thin basement membrane disease
Explanations & Answers:
Question Easy Answer: B) Renal colic due to a kidney stone
Question Easy Explanation: The patient’s presentation of acute severe loin pain that radiates to the groin, along with microscopic haematuria, is classic for renal colic due to a kidney stone. According to NICE guidelines, this is a common differential diagnosis in young adults with such symptoms.
Question Medium Answer: B) Pre-renal acute kidney injury
Question Medium Explanation: This scenario is indicative of pre-renal acute kidney injury, likely due to volume depletion or reduced renal perfusion, especially in a patient with hypertension and diabetes. The lab findings of elevated creatinine, high potassium, and low sodium align with this diagnosis per NICE guidelines on acute kidney injury management.
Question Hard Answer: C) Autosomal dominant polycystic kidney disease
Question Hard Explanation: The combination of recurrent haematuria, flank pain, bilateral kidney cysts, and a positive family history, along with a PKD1 gene mutation, is consistent with autosomal dominant polycystic kidney disease. This condition is well-defined in NICE genetics guidelines and typically presents around the fourth decade of life.
Medical fact of the day: In the UK, Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common genetic disorders, affecting about 1 in 1000 people. It’s a significant cause of end-stage renal disease.
Quote of the day: “In the tapestry of healthcare, every thread has a unique role. Hold steady, stay resilient, and let your work weave hope into every life you touch.”