A 68-year-old man presents to the emergency department with severe abdominal pain, headache, chest pain, and shortness of breath for the past three days. He has a history of coronary artery disease, asthma, and hypertension diagnosed three months ago, which has been resistant to hydrochlorothiazide and lisinopril. Over the last month, his GFR has rapidly declined. On examination, his blood pressure is 210/115 mmHg, and he has diffuse pulmonary crackles bilaterally. An abdominal bruit is noted on the left side. A chest X-ray shows bilateral fluffy pulmonary infiltrates. Renal artery stenosis is suspected. What is the most likely cause of renal artery stenosis in this patient?
A 68-year-old man presents to the emergency department with severe abdominal pain, headache, chest pain, and shortness of breath for the past three days. He has a history of coronary artery disease, asthma, and recently diagnosed hypertension that has been resistant to treatment with hydrochlorothiazide and lisinopril. Over the past month, his glomerular filtration rate (GFR) has rapidly declined. On physical examination, his blood pressure is 210/115 mmHg, and he has diffuse pulmonary crackles bilaterally and an abdominal bruit on the left side. A chest X-ray shows bilateral fluffy pulmonary infiltrates. Renal artery stenosis is suspected. What is the gold standard for diagnosing renal artery stenosis?
A 64-year-old female with schizophrenia and chronic kidney disease is being considered for erythropoietin-stimulating agent (ESA) therapy with epoetin alfa. Her current medications include clozapine and hydrochlorothiazide. What is the most common side effect of epoetin alfa therapy?
A 73-year-old woman with stage 4 chronic kidney disease has a hemoglobin level of 7.9 g/dL. She asks whether she is a good candidate for erythropoietin-stimulating agent (ESA) therapy. Of the following, which is a true statement about erythropoietin and ESAs?
A 65-year-old male with chronic kidney disease and anemia is started on epoetin alfa therapy. During follow-up visit, you educate the patient about the potential side-effects of epoetin alfa therapy. Which of the following is the most common side effect of epoetin alfa therapy?
A 68-year-old male comes to your office feeling weak and fatigued for the past 10 days. His past medical history is significant for stage III chronic kidney disease with a glomerular filtration rate (GFR) of 45 mL/min. Laboratory tests reveal a hemoglobin concentration of 8 g/dL. You diagnose the patient with anemia of chronic kidney disease. The principal mechanism in this disorder involves which of the following?
A 72-year-old man presents to the emergency department with persistent vomiting, inability to eat or drink for 2 days, and severe back pain. He has been taking ibuprofen (800 mg three times daily), lisinopril for hypertension, and aspirin for stroke prevention. He reports diminished urine output of 200 mL over the last 24 hours. Vital signs: Temperature: 98.8 °F Heart rate: 162 bpm Respiratory rate: 17 bpm Blood pressure: 90/55 mmHg Oxygen saturation: 97% on room air The patient has multiple risk factors for prerenal azotemia. Which of the following urine findings is most likely in this patient?
A 20-year-old female college student presents to the university health center with complaints of dysuria, urgency, and frequency of urination. She denies any fever, chills, or flank pain. On physical examination, mild suprapubic tenderness is noted. A urinalysis reveals the presence of leukocyte esterase and nitrites, suggestive of a urinary tract infection (UTI). Urine culture identifies Staphylococcus saprophyticus as the causative organism. Which of the following are the key identifying features of this organism?
A 22-year-old sexually active woman presents to the clinic with a 3-day history of dysuria, urinary frequency, and lower abdominal discomfort. She denies fever, chills, or flank pain. Her past medical history is unremarkable, and she reports no previous urinary tract infections. Physical examination reveals mild suprapubic tenderness without costovertebral angle tenderness. A urinalysis shows pyuria, bacteriuria, and microscopic hematuria. A urine culture grows Staphylococcus saprophyticus. Which of the following characteristics differentiates Staphylococcus saprophyticus from other coagulase-negative staphylococci?
A 56-year-old woman with poorly controlled diabetes mellitus presents with fever, severe left flank pain, confusion, and hypotension. Laboratory findings reveal leukocytosis, elevated serum glucose, and acute kidney injury. A non-contrast CT scan shows gas in the left renal parenchyma and perinephric area. Which of the following is the most appropriate initial management for this patient?
