Case Challenges
Quiz
175Nephrology
A 64-year-old female presents with a 2-week history of generalized swelling. On examination, she has grade 4 pitting edema in both lower extremities. She is admitted to the hospital, and the following laboratory results are obtained:
Two months ago, her serum creatinine was 0.6 mg/dL. After admission, her daily urine output decreased to approximately 300 mL. Bilateral pleural effusions gradually developed, and she did not respond to diuretic therapy, so hemodialysis was initiated. A kidney biopsy was performed (see Figures). Serologic testing revealed MPO antibody >134 IU/mL, with no other significant findings. Which of the following is the most appropriate treatment?
Protein/Albumin: 6.2/2.5 g/dL
BUN/Creatinine: 54.3/6.4 mg/dL (eGFR 7 mL/min/1.73 m²)
Na/K/Cl/tCO2: 136/4.4/102/20.8 mmol/L
110Nephrology
A 52-year-old male presents to the emergency department with a 3-hour history of left flank pain. His vital signs, laboratory results, urinalysis, and imaging studies are summarized below. What is the most appropriate next step in his management?
103Nephrology
A 45-year-old female patient presented with a 3-day history of headache and fever. She had no significant past medical history. After being diagnosed with pelvic inflammatory disease, she was treated with ceftriaxone, metronidazole, and doxycycline. Although her fever and infection improved, she suddenly developed oliguria (decreased urine output) on the 12th day of antibiotic therapy and was referred to the nephrology department. Laboratory tests and urinalysis were performed, and a kidney biopsy was obtained to determine the cause. Among the following statements regarding this condition, which one does not accurately represent an appropriate explanation or treatment?
79Nephrology
A 20-year-old female presents with intermittent abdominal pain, bilateral visual disturbances, and elevated blood pressure. Laboratory studies, fundoscopic examination, abdominal CT, and angiography were performed (Figures 1, 2, 3). What is the patient’s diagnosis?
75Nephrology
A 57-year-old female has felt fatigued for 3 months and noticed lower-extremity swelling for the past week. Laboratory studies and a kidney biopsy (Figures 1 and 2) are shown. What is the most appropriate treatment?
Serum BUN/creatinine : 45/1.5 mg/dL
24hour urine protein : 890 mg/day
Urinalysis : Protein (2+), Occult blood (2+), RBC 5-9 /HPF
ANA titer (1:40), Anti-dsDNA (-)
MPO Ab (+), PR3 Ab (-)
30Nephrology
A 29-year-old man was referred to the hospital after proteinuria was incidentally discovered during a routine health examination. He reported a history of anhidrosis and occasional burning pain in his hands and feet. Past medical history was otherwise unremarkable. Physical examination revealed absent axillary hair, along with spotted lesions on the buttocks and chest. His mother had a history of hypertension, heart failure, and ventricular tachycardia (requiring pacemaker placement), as well as a cerebrovascular event at age 40. Current vital signs included a blood pressure of 130/80 mmHg, heart rate of 65 beats/min, and respiratory rate of 20 breaths/min. The following are his lab results (A) and kidney biopsy findings (B):
A) Laboratory Findings
Hb 13.6 g/dl, Total Protein 6.9 g/dl, Albumin 3.9 g/dl, Total cholesterol 173 mg/dl
BUN 22.4 mg/dl, Creatinine 2.53 mg/dl
Na 142 mmol/L, K 4.7 mmol/L, Cl 107 mmol/L
HBsAg/HBsAb negative/negative, HCV Ab negative, HIV Ab negative
U/A Protein ++++, RBC 0-2/HPF, WBC 0-5/HPF, Urine PCR 4.79 g/g Cr
B) kidney biopsy
20Nephrology
A 57-year-old male was found to have an incidental renal cyst during a routine health examination. An abdominal CT scan was performed (Figures A and B). Which of the following is the most appropriate next step in management?
