Nephrology

A 34-year-old woman presents with persistent microscopic hematuria and intermittent urinary discomfort for 3 years. Hb 120g/L, urinary protein 2g/24h, urinary RBCs 20-30/HP, WBC 2-3/HP. Urinary RBC phase-contrast microscopy shows: 20% normal morphology, 80% dysmorphic. The most critical next step is:

A 30-year-old female patient with a 12-year history of proteinuria and intermittent hematuria developed gross hematuria 2 days after a cold. BP 146/94 mmHg, urinary protein (++++)(5g/d), urine sediment shows full-field dysmorphic RBCs, normal renal function, serum ALb 20g/L, Hb 70g/L, ANA 1:80, complement C3 0.5g/L. The most likely diagnosis is:

A 60-year-old male with a 10-year history of diabetes mellitus (DM) has laboratory tests showing 24-hour urinary albumin of 120mg and serum albumin (Alb) of 40g/L. The most likely diagnosis is:

A 48-year-old male with a 5-year history of non-insulin-dependent diabetes mellitus (DM) presents with bilateral lower extremity edema. Physical examination: blood pressure (BP) 150/94 mmHg, urinalysis (UA) shows protein (++++), red blood cells (RBC) 10-15/HP, 24-hour urinary protein quantification 4.0 g, plasma albumin (Alb) 30 g/L, serum cholesterol 6.5 mmol/L, serum creatinine (Cr) 120 μmol/L, urine disc electrophoresis shows high molecular weight proteinuria, and serum HBV markers are positive. Fundus examination is negative. The most likely clinical diagnosis is:

A 60-year-old female with a 5-year history of diabetes mellitus (DM) presents with bilateral lower extremity edema for 1 year. Physical exam: BP 160/80 mmHg, heart rate 80 bpm, regular rhythm, clear breath sounds in both lungs, and pitting edema in both lower extremities. Urinalysis (UA) shows proteinuria (+++), RBCs 2-3/HP, and UTP 5g. Renal pathology: immunofluorescence IgG(+), IgA(-), IgM(-), C3(-), C1q(-), Alb(+), with linear IgG and Alb deposits along capillary walls. Light microscopy reveals 15 glomeruli with mild mesangial cell and matrix proliferation, segmental aneurysmal dilatation, and K-W nodules. The diagnosis is:

A 67-year-old male with a 15-year history of hypertension (HTN), overweight, and a 26-year history of hyperlipidemia recently presented with mild bilateral renal atrophy, serum creatinine (Cr) 280 μmol/L, blood urea nitrogen (BUN) 9.7 mmol/L. Renal artery angiography revealed localized stenosis of bilateral renal arteries. The most appropriate management is:

Which antihypertensive drug is contraindicated in a patient with chronic renal failure (early stage) and hypertension due to bilateral renal artery stenosis?

A 35-year-old woman presents with low back pain, frequency of urination, and dysuria for 3 days, with recurrent similar episodes over the past 3 years. Urinalysis (UA): WBC 30-40/HP, RBC 20-30/HP; midstream urine culture shows bacterial growth; renal ultrasound: bilateral kidneys show hyperechoic masses distributed along the renal pyramids in a radial pattern, with multiple small stones; IVP 1 year ago revealed multiple cysts and dilated tubules in both kidneys, with contrast filling the renal pyramids forming irregular shadows in a 'bouquet' pattern. The most likely diagnosis is:

A 35-year-old male was admitted for evaluation after routine urinalysis revealed proteinuria (++), 0-5 RBCs/HP, and 0-1 granular casts/HP. Further tests showed lipiduria and 24-hour urinary protein quantification of 0.98g. Physical examination revealed clustered dark-red telangiectasias on the lower abdomen, conjunctival and fundus vascular dilatation, moderately elevated BP, and leftward cardiac enlargement. Blood tests showed normal renal function but markedly reduced α-galactosidase A activity. Renal biopsy demonstrated foamy enlarged parietal epithelial cells in Bowman's capsule. The most likely diagnosis is:

Using the BUN:Scr (mg/dl) ratio to differentiate between prerenal azotemia and acute tubular necrosis

A 30-year-old female patient is admitted with facial rash, bilateral lower extremity edema for 2 years, and decreased urine output for 1 week. BP 150/90 mmHg, urinary protein 6.5 g/d, RBCs covering the field of view, serum ALB 26 g/L, serum creatinine 256 μmol/L, C3 decreased, ANA(+), and ultrasound shows slightly enlarged kidneys. The most likely diagnosis is:

A patient with chronic renal insufficiency usually has slightly elevated blood pressure. In the past two days, BP reached 200/110mmHg. What is the most appropriate action?

A 40-year-old woman presents with thirst, polydipsia, and polyuria for 2 months, with a urine output of 5000-7000ml/d. The first investigation to perform is:

A 15-year-old male presents with sore throat, cough, headache, fatigue, and decreased appetite for 2 weeks, followed by cloudy red-brown urine without urinary frequency, urgency, or pain. He has eyelid and facial edema, blood pressure 150/90 mmHg, hemoglobin 102 g/dL, erythrocyte sedimentation rate (ESR) 45 mm/h, mildly elevated serum creatinine and blood urea nitrogen (BUN), markedly elevated anti-streptolysin O, and low complement C3. Acute glomerulonephritis is diagnosed. The cloudy red-brown urine is:

A 24-year-old female patient had sore throat and fever 6 months ago. Two days later, she developed gross hematuria throughout urination, with mild urinary frequency and dysuria. Two weeks ago, she had another episode of gross hematuria with low back pain after a cold. BP is 130/80 mmHg, urinary protein (++), and sediment shows RBCs throughout the field of view. Which test is most helpful for identifying glomerular-origin hematuria?

A 45-year-old male presents with significant bilateral lower limb edema. Physical exam: BP 120/82 mmHg, macroglossia, hemorrhagic oral bullae, slurred speech, marked cardiomegaly, grade III systolic blowing murmur at the apex radiating to the left axilla, liver palpable 2 cm below costal margin with firm consistency, spleen palpable 2 cm below costal margin with hard consistency, ascites sign (+), prominent pitting edema in both lower limbs. Hb 95 g/L, urinary protein (++++), 24-hour urinary protein quantification 4.5 g, disc electrophoresis shows high molecular weight proteinuria, serum albumin 32 g/L, serum creatinine 180 μmol/L, CXR shows generalized cardiomegaly with bilateral pleural effusion. The patient has a history of frequent diarrhea with unremarkable stool studies. The most likely diagnosis is:

A 22-year-old female presents with chills, fever, flank pain, dysuria, frequency, and urgency of urination for 1 day. Laboratory tests show urinalysis (UA) with white blood cell (WBC) count covering the entire field. Which management approach should be chosen?

A 30-year-old woman presents with low back pain, frequency of urination, and urgency. Blood pressure is 160/100 mmHg, urinary protein (+), red blood cells 8-10/HP, white blood cells 15-20/HP. Intravenous pyelogram (IVP) shows right kidney atrophy with calyceal dilation. The most likely diagnosis is:

A 40-year-old woman presents with 5 days of high fever, low back pain accompanied by frequency of urination, dysuria, and urgency. She took ciprofloxacin for 2 days without improvement. No prior similar episodes. A renal pelvis stone was detected 1 month ago but left untreated. Exam: temperature 39°C, right costovertebral angle tenderness. Urinalysis: urinary protein (+), WBC 20-30/HP, occasional WBC casts, urine specific gravity (USG) 1.025. The most likely diagnosis is:

A 48-year-old woman presents with recurrent severe arrhythmias due to hyperkalemia. Laboratory findings: serum potassium 6.0 mmol/L, serum chloride 110 mmol/L, CO2CP 16 mmol/L, urine pH 5.5. After correcting acidosis, the fractional excretion of sodium bicarbonate is 3%, and endogenous creatinine clearance is 45 ml/min. The most likely diagnosis is:

A 38-year-old woman presents with sudden onset of severe right flank pain and gross hematuria. She has a history of rheumatic valvular disease with atrial fibrillation. Urinalysis (UA) shows protein++, red blood cells (RBCs) throughout the field of view, and white blood cell (WBC) count 5-8/HP. The most likely clinical diagnosis is:

A 26-year-old female presents with recurrent oral ulcers and arthralgia for 2 years, accompanied by photosensitivity. Two weeks ago, she developed bilateral lower extremity edema. Laboratory tests: Urinalysis shows proteinuria (+++), RBCs 10-20/HP, and ANA(+). Renal biopsy pathology reveals mild mesangial cell and matrix proliferation, endothelial cell proliferation, subendothelial and subepithelial eosinophilic deposits, and partial crescent formation. Immunofluorescence: IgA(++), IgG(+++), IgM(+++), C1q(++), C3(++). The diagnosis is:

A 30-year-old female presents with facial rash, bilateral lower extremity edema for 2 years, and decreased urine output for 1 week. BP 150/90 mmHg, urinary protein 6.5g/d, RBCs in full field of view, serum ALB 26g/L, serum creatinine 256μmol/L, C₃ decreased, ANA(+), and ultrasound shows slightly enlarged kidneys. The most likely diagnosis is:

A 67-year-old male presents with 3 months of lumbosacral pain and weight loss. Blood pressure (BP) is normal. There is lumbar spine tenderness and bilateral lower extremity edema. Hemoglobin (Hb) is 62g/L, urinary protein ++++, serum calcium (Ca) 4.6mmol/L, alkaline phosphatase 280U/L, and γ-globulin 45%. The most likely type of proteinuria is:

A 28-year-old male presents with edema and oliguria for 1 week, with a history of 'cold' 2 weeks ago. BP: 150/90 mmHg, Hb 80 g/L, urinary protein (+++), occult blood (+++), urinary RBCs 15-20/HP, serum creatinine 384 μmol/L. Ultrasound shows left kidney 11.1×4.1×5.2 cm, right kidney 12.2×4.8×5.4 cm. What is the next best step?

A 40-year-old male presents with edema and oliguria for 1 week. BP 160/100 mmHg, urinary protein 2g/24h, urinary RBCs 20-30/HP, serum creatinine 600 μmol/L, circulating immune complexes (CIC) (+). Renal pathology: Light microscopy shows 11 glomeruli, partial capillary narrowing, 6 cellular crescents, 3 fibrous crescents. IgG and C3 show granular deposition along capillary walls and mesangium. The diagnosis is:

A 32-year-old male patient presented with sore throat and cough 2 weeks ago, followed by edema, oliguria, and fatigue in the past week. Laboratory tests showed hemoglobin (Hb) 90g/L, urinary protein (+++), urine sediment microscopy with 10-15 red blood cells (RBCs)/HP, normal blood C3, serum creatinine 500 μmol/L, blood urea nitrogen (BUN) 23 mmol/L, and ultrasound revealing bilateral enlarged kidneys. The most likely diagnosis is:

A 30-year-old male with 3 years of proteinuria, BP 130/70 mmHg, urinary protein 4g/24h, occult blood (++). Renal pathology shows severe mesangial cell and matrix proliferation, partial capillary narrowing, interstitial lymphocyte infiltration, and tubular atrophy with fibrosis. Which treatment regimen is most appropriate?

A 34-year-old male presents with periorbital edema upon waking for 2 years, lumbago, and physical examination reveals BP 167/93 mmHg, pitting edema in both ankles. Lab findings: Hb 101g/L, UA: protein ++, RBC 10-15/HP, WBC 0-3/HP, 24-hour urinary protein quantification 1.8g, plasma albumin 34g/L, serum Cr 133.8 μmol/L, BUN 10.5 mmol/L. The most likely diagnosis is:

A 30-year-old male presents with 2 years of dizziness and fatigue. Blood pressure is 160/100 mmHg, no edema, hemoglobin 80 g/L, urine specific gravity 1.014, urinary protein (++), granular casts 0-2/HP, BUN 16.4 mmol/L (46 mg/dL), serum creatinine 309.4 μmol/L (3.5 mg/dL), CO2CP 22 mmol/L (50 VOL%). Fundoscopy shows narrowed and tortuous retinal arteries. The most likely diagnosis is:

A patient with chronic nephritis for 5 years, on a long-term low-salt and low-protein diet, presents with fatigue, nausea, and vomiting for 20 days. BP is 140/100 mmHg, no edema, Hb 60 g/L, urinary protein (+), granular casts 0-3/HP, serum albumin 30 g/L, globulin 25 g/L, BUN 20 mmol/L, serum Cr 1220 μmol/L, serum Na 125 mmol/L. What is the main cause of anemia in this patient?

A 15-year-old male presents with sudden-onset generalized edema for half a month. Examination: BP 120/70 mmHg, pitting edema of eyelids and lower limbs, urinary protein (+++), BLD (-), 24-hour urinary protein quantification 6.8g, serum albumin 20g/L, BUN 10.7mmol/L, Cr 125μmol/L. The first-line treatment is:

A patient presents with severe generalized edema and ascites. Laboratory findings show urinary protein (+++), 24-hour urinary protein >3.5g, hyperlipidemia, and plasma protein <30g/L. What is the primary diagnostic criterion for nephrotic syndrome in this case?

A 36-year-old female patient with diagnosed nephrotic syndrome has developed right lower limb pain, coldness, non-palpable dorsalis pedis artery pulse, and toe cyanosis over the past two days. The most likely complication to consider first is:

A 17-year-old male presents with severe generalized edema, urinary protein 6.4g/24h, plasma albumin 23g/L, blood pressure 80/60mmHg, renal function BUN 9.1mmol/L, Cr 100μmol/L. The primary treatment of choice is:

A 36-year-old male presents with generalized edema, urinary protein 8.6g/d, red blood cells (RBC) 5-10/HP in urine, fatty casts, and plasma albumin (Alb) 18g/L. Despite treatment with prednisone 60mg daily and dipyridamole 300mg (divided into 3 doses) for 8 weeks, there is no improvement. Which of the following measures is most appropriate?

An 18-year-old male developed hematuria 2 days after an upper respiratory tract infection (URI), accompanied by low-grade fever and low back pain. Systemic symptoms improved after hospitalization, but hematuria persisted. Renal biopsy led to a diagnosis of IgA nephropathy. The primary diagnostic basis is:

For patients with complicated acute pyelonephritis, which of the following antibiotics is NOT typically chosen before obtaining drug sensitivity results of the causative pathogen?

A 63-year-old female patient with a history of coronary artery disease (CAD) presents with recurrent edema and oliguria for 10 years. Laboratory findings: Hb 70g/L, BP 20/13.3 kPa, urinary protein (++), 6-10 RBCs/HPF, 2-3 WBCs/HPF, urine specific gravity 1.010-1.012. Clinical diagnosis: chronic glomerulonephritis (CGN). Blood tests: BUN 31mmol/L, Cr 407μmol/L, Ccr 40ml/min. Which renal function stage does this patient belong to?

A 40-year-old male presents with fever and rhinorrhea for 3 days, followed by nausea, vomiting, oliguria, and fatigue. Blood pressure is 160/100 mmHg, hemoglobin 70 g/L, serum creatinine 707.2 μmol/L (8 mg/dL), blood urea nitrogen 57 mmol/L (100 mg/dL), total plasma protein 48 g/L, and ultrasound shows both kidneys with a long axis of 8 cm. The most likely diagnosis is:

A 42-year-old male with chronic nephritis with uremia has undergone hemodialysis for 3 months, with weekly hemofiltration, and subcutaneous injection of erythropoietin for 4 months. Apart from antihypertensive drugs, the patient takes no other medications. Uremic symptoms are controlled, but anemia is significant (Hb 6.5 g/dL). To investigate the cause of anemia, which test should be prioritized?

A 65-year-old male with 25-year history of hypertension (HTN) presents with poor appetite and fatigue for over 3 months. Examination: BP 195/98 mmHg, apathy, questionable flapping tremor (asterixis) in upper limbs, intermittent involuntary movements in lower limbs, bilateral ankle clonus (+). Normal liver function. Lab: serum creatinine 1000 μmol/L, hemoglobin (Hb) 65 g/L, serum calcium (Ca) 1.9 mmol/L, serum phosphorus (P) 3.0 mmol/L, serum potassium (K) 5.5 mmol/L, CO₂CP 18 mmol/L. The most likely cause of neurological changes is:

A 56-year-old male was admitted with oliguria for 1 week. His blood pressure (BP) was 180/120 mmHg, with somnolence, anemia, facial and bilateral lower extremity edema. Lab results: blood urea nitrogen (BUN) 42 mmol/L, creatinine (Cr) 1380 μmol/L, serum potassium (K) 6.2 mmol/L, serum calcium (Ca) 2.0 mmol/L, CO2 combining power 12 mmol/L. During correction of acidosis, he suddenly developed tetany but remained alert and oriented, with no pathological signs. The most likely cause of tetany is:

A 75-year-old male with a 3-year history of diabetic nephropathy presents with paroxysmal nocturnal dyspnea for 1 week. BP 90/50 mmHg, bilateral basilar rales, heart rate 160 bpm with irregular rhythm, bilateral lower extremity edema, BUN 35 mmol/L, creatinine 1210 μmol/L, CO₂ combining power 9 mmol/L. The most appropriate treatment at this stage is:

An 18-year-old female developed fever due to acute suppurative tonsillitis 3 weeks ago, which improved after treatment. Recently, she presented with periorbital edema, elevated blood pressure, oliguria, dyspnea, and inability to lie flat. Which tests should be prioritized?

A 22-year-old male presents with bilateral lower extremity edema and fatigue 10 days after a cold. BP 155/105 mmHg, urinary protein (++), red blood cells (++++), granular casts 1-4/HPF, serum creatinine 106 μmol/L, hemoglobin 122 g/L. The most likely diagnosis is:

A 15-year-old male student developed frothy urine and fatigue after participating in a 10,000-meter race at school. Urinalysis showed proteinuria (1+), which normalized after one day of rest. Six months later, he again developed frothy urine with proteinuria (3+) measuring 3.2g/24h, accompanied by periorbital edema and bilateral lower limb edema. The most appropriate investigation is:

A 20-year-old male presents with fatigue and poor appetite for 1 month, oliguria, edema, and hypertension (HTN) for 1 week. Lab findings show anemia, hematuria, proteinuria, normal complement C3, elevated serum creatinine and blood urea nitrogen (BUN), and bilateral enlarged kidneys on ultrasound. Clinical diagnosis is acute kidney injury (AKI). If both anti-glomerular basement membrane (GBM) antibody and antineutrophil cytoplasmic antibody (ANCA) are negative, which of the following is the most likely diagnosis?

A 60-year-old male truck driver with a 30-year smoking history presents with edema, oliguria, and progressive renal dysfunction over 1 month. One month ago, his BP was 160/95 mmHg, UA showed PRO(+++), RBCs 15-20/HPF, Cr 168 μmol/L, BUN 9.5 mmol/L, and CBC revealed mild anemia. Diuretics provided no significant edema relief. At our clinic, repeat tests show BUN 19.6 mmol/L and Cr 388 μmol/L. What is the most likely diagnosis?

A 50-year-old male presents with edema and oliguria for 1 week. BP 160/100 mmHg, urinary protein 3g/24h, urinary RBCs 20-30/HPF, creatinine (Cr) 633 μmol/L, blood CIC (+). Renal pathology: Light microscopy shows 17 glomeruli with partial capillary narrowing, 6 cellular crescents, and 8 fibrocellular crescents. IgG and C3 show granular deposits along capillary walls and mesangial areas. The primary pathogenesis is:

A 68-year-old female presents with low-grade fever, myalgia, and bilateral lower extremity edema for 25 days, oliguria for 3 days, and hemoptysis for 1 day. Hemoglobin is 83g/L, urinalysis shows proteinuria, RBCs throughout the field of view, WBC count 20/HPF, 24-hour urinary protein quantification 3.7g, plasma albumin 29.6g/L, and serum creatinine 524μmol/L. To confirm the etiology, the preferred initial test is:

A 30-year-old male with 1-year history of hypertension (HTN) presents with fever, sore throat for 3 days and gross hematuria for 1 day. Physical exam: BP 160/100 mmHg, pharyngeal erythema, tonsils grade II, no lower limb edema. Laboratory tests: urinary protein 2.56g/d, urine sediment shows RBCs covering entire field, serum creatinine 210 μmol/L, urine specific gravity 1.018, normal liver function, negative hepatitis B serology, elevated blood IgA. No family history of HTN. The most likely pathological diagnosis is:

A 69-year-old male presents with bilateral lower extremity edema for 4 months. Four months ago, lab results showed hemoglobin (Hb) 150g/L, urinalysis (UA) protein-positive, 24-hour urinary protein quantification 5.9g, plasma albumin (Alb) 19.2g/L, and serum creatinine (Cr) 108μmol/L. What is the most likely pathological type?

A 30-year-old male presents with recurrent periorbital edema and nocturia for 2 years, BP 160/100 mmHg, urinary protein (+), RBC 5–10/HPF, granular casts 1–2/HPF, serum creatinine 145 μmol/L, hemoglobin 85 g/L, serum albumin 32 g/L. Which of the following clinical findings is LEAST relevant for diagnosis?

A 33-year-old male with a history of proteinuria 15 years ago, left untreated. Developed nausea and vomiting 3 weeks ago. Examination: BP 190/120 mmHg, mild lower limb edema, serum creatinine 360 μmol/L, ultrasound shows bilateral kidney shrinkage. The most likely primary disease is:

A 23-year-old female patient developed bilateral lower extremity edema with reduced urine output 3 days after fever and sore throat. Blood pressure (BP) is 160/100 mmHg, hemoglobin (Hb) 92 g/L, urinary protein (2+), red blood cells (RBC) (+++), granular casts 0-2/HPF, and serum albumin (Alb) 32 g/L. Which of the following tests is most significant for diagnosis and treatment in this case?

A 30-year-old woman presents with lower extremity edema for 2 weeks. Physical examination: blood pressure (BP) 200/100 mmHg, urinary protein (+++), red blood cells (RBC) 10-15/HPF, serum creatinine (Cr) 150 μmol/L, serum albumin (Alb) 32 g/L. The next diagnostic step for this case should be:

A 60-year-old woman with intermittent edema for 2 years, worsening over half a month, accompanied by dyspnea and hemoptysis for 3 days. BP 150/90 mmHg, positive ascites sign, urinary protein (++++), RBC 0-2/HPF, serum albumin 20 g/L, triglycerides 2.1 mmol/L, enlarged kidneys, and thrombosis in the main renal veins. If a renal biopsy is performed, the most likely pathological type is:

An 18-year-old male presents with nephrotic syndrome. 24-hour urinary protein is 4.5g, urine disc electrophoresis shows mid-molecular proteinuria (selective proteinuria), marked edema, normal blood pressure (BP) and renal function. He had a similar episode in childhood which achieved complete remission (CR) after standard steroid therapy, with negative urinalysis until this recurrence. After 8 weeks of treatment, proteinuria shows only slight reduction with no other significant improvement. At this stage, the best approach is:

A 36-year-old male presents with edema and oliguria for 1 week. BP is 120/80 mmHg, urinary protein (++++), plasma albumin 25g/L, and 24h total proteinuria 9g. Which laboratory test has the highest diagnostic value?

A 16-year-old male presented with sudden severe edema, normal blood pressure (BP), ascites sign (+), urinary protein (++++), 0-2 red blood cells (RBC)/HPF, 24-hour urinary protein quantification 6g, serum creatinine (Cr) 100μmol/L, normal blood C3 and CH50, serum albumin 24g/L. After admission, he was given oral prednisone 40mg daily. Renal biopsy at 2 weeks showed mild mesangial proliferation, vacuolar degeneration of tubular epithelial cells, negative immunofluorescence, and foot process effacement on electron microscopy. Proteinuria significantly decreased at 6 weeks, with complete remission (CR) achieved by 8 weeks. The pathological diagnosis in this case is:

A 32-year-old female presents with proteinuria and hematuria for 3 years. Three years ago, urinalysis (UA) showed protein (+) and 10-20 RBCs/HPF, with blood pressure 125-135/80-90 mmHg and normal renal function. Over 3 years, 24-hour urinary protein quantification ranged 0.6-1.4g. One month ago, she developed sore throat and fever after a cold, followed by gross hematuria. Antibiotics improved her sore throat, but UA still showed protein (++) and 12 RBCs/HPF. Repeat renal function tests showed BUN 10.4 mmol/L and Cr 345 μmol/L. Renal biopsy pathology report: Immunofluorescence: IgG(+), IgA(+++), IgM(-), C3(++), C1q(-), FRA(-), Alb(-), with granular deposits in capillary walls, mesangium, and Bowman's capsule. Light microscopy: 36 glomeruli with diffuse mesangial/endothelial cell proliferation, leukocyte infiltration, severe capillary loop destruction, 18 cellular crescents, 5 fibrocellular crescents, 4 fibrous crescents, tubular atrophy with RBC casts, and interstitial lymphocytic/monocytic infiltration. Diagnosis is:

A 28-year-old male developed nausea, fatigue, low-grade fever, and arthralgia 3 days after taking ciprofloxacin for a cold 15 days ago. Urinalysis showed glycosuria, urinary protein, 15-20 RBCs/HPF, Scr 360 μmol/L, low serum potassium (K), low serum phosphorus (P), and low urine osmolality. Bilateral enlarged kidneys were noted. Which diagnostic test is most appropriate?

A 35-year-old woman presents with frequency, urgency, and dysuria for 5 days, fever (39.5°C), left costovertebral angle tenderness, urinalysis shows protein (++), white blood cell (WBC) count covering the entire field, and red blood cells (RBC) 5-10/HPF. The most likely diagnosis is:

A 35-year-old woman presents with frequency, urgency, and dysuria for 5 days, fever (39.5°C), left costovertebral angle tenderness. Urinalysis shows protein (++), WBCs covering the field, and 5-10 RBCs/HPF. The most likely diagnosis is:

A 35-year-old woman was admitted with fever, chills, and low back pain for 5 days. Right renal area showed percussion tenderness. Urinalysis (UA): red blood cells (RBC) 5-6/HPF, white blood cell (WBC) count 20-30/HPF. Midstream urine culture revealed Escherichia coli >10⁵/ml. After 3 days of antibiotic therapy, her temperature normalized. At discharge after 2 weeks, UA was normal, urine culture was negative, no fever persisted, but she still had abdominal pain without renal percussion tenderness. What should be emphasized post-discharge?

A 64-year-old woman with a BP of 162/90 mmHg six months ago (normal urinalysis and renal function) has been on captopril since then. One month ago, she developed polyuria, fatigue, and BP of 190/110 mmHg. UA: protein +, renal function: BUN 16 mmol/L, Cr 324 μmol/L, serum K 3.0 mmol/L. Renal ultrasound: left kidney 11.8 cm × 5.2 cm, right kidney 9.0 cm × 3.8 cm. What is the most appropriate initial treatment?

A 23-year-old female was admitted with recurrent arthralgia for over a year and edema for 1 month. Physical examination: BP 150/90 mmHg, marked facial and lower extremity edema, knee joint swelling and mild tenderness. Lab findings: Hb 78g/L, WBC 3.0×10⁹/L, PLT 50×10⁹/L, urine protein (++++), RBC 10-20/HPF, WBC 5-10/HPF, 24-hour urinary protein quantification 5.6g (non-selective proteinuria), ALT 50U, A/G=30/40g/L, serum IgG 22g/L. After evaluation, she was diagnosed with diffuse proliferative lupus nephritis. In addition to prednisone and anticoagulation therapy, which of the following should be added?

A 50-year-old male patient was admitted with 'rash on both lower limbs, abdominal pain, and arthralgia for 1 week, and edema for 3 days'. Physical examination: BP 160/90 mmHg. Renal pathology showed: immunofluorescence IgG(-), IgA(+++), IgM(++), C3(-), C1q(-), Alb(-), with mass-like and granular deposits in the mesangial area. Light microscopy revealed 22 glomeruli, 2 cellular crescents, 2 global sclerosis, and mild diffuse proliferation of mesangial cells and matrix with mesangial eosinophilic deposits. There was multifocal mononuclear and lymphocyte infiltration in the renal interstitium. If urinalysis shows proteinuria (+++), RBCs 20–25/HPF, and 24-hour urinary protein quantification of 2.58 g, which treatment should be administered?

A 24-year-old male patient is admitted with 'recurrent gross hematuria for 1 month, oliguria and edema for half a month, and hemoptysis for 2 days'. Physical examination: BP 160/90 mmHg, coarse breath sounds in both lungs with basal rales. Bilateral lower extremity edema. Lab tests: UA shows Pr (++), RBCs 20-25/HPF; CBC shows moderate anemia; anti-GBM antibody (+), ANCA (-). Renal pathology reveals: immunofluorescence IgG (++), IgA (-), IgM (+), C3 (++), C1q (-), Alb (-), with IgG and C3 showing smooth linear deposition along glomerular capillary walls. Light microscopy demonstrates crescentic glomerulonephritis. The definitive diagnosis is:

A 56-year-old male presents with lumbosacral pain for over 1 year and proteinuria for 3 months. Investigations: erythrocyte sedimentation rate (ESR) 23mm/h, hemoglobin (Hb) 8g/dl, urinary protein electrophoresis shows predominantly low molecular weight proteins, serum creatinine (Scr) 152μmol/L. What is the preferred diagnostic test to identify the etiology?

A 23-year-old male patient, previously healthy, presents with edema, hematuria, and nephrotic-range proteinuria for over 1 year. His blood pressure is 165/95 mmHg. Given the presence of nephrotic-range proteinuria, his 24-hour urinary protein quantification would likely be:

A 36-year-old male presents with edema and oliguria for 1 week. Blood pressure is 120/80 mmHg. Urinalysis shows protein ++++. Plasma albumin is 25 g/L, and 24-hour urinary protein quantification is 9 g. Which laboratory test has the highest diagnostic value in this case?

A 35-year-old male presents with lower extremity edema for 2 weeks, blood pressure 28/14 kPa, urine protein +++, red blood cells 10 to 15 per high power field (HPF), urine glucose positive, serum creatinine 160 μmol/L, and serum albumin 32 g/L. The next best diagnostic step is:

A 36-year-old woman presents with lower extremity edema for 3 weeks, blood pressure (BP) 200/100 mmHg, urine protein +++, red blood cells (RBC) 15–20/HPF, serum creatinine (Cr) 156 μmol/L, and serum albumin 34 g/L. Which investigation is most critical?

A 30-year-old male presents with recurrent periorbital edema and nocturia for 2 years, blood pressure 160/100 mmHg, urinary protein (+), red blood cells 5-10/HPF, granular casts 1-2/HPF, serum creatinine 145 μmol/L, hemoglobin 85 g/L, and serum albumin 32 g/L. The most likely diagnosis is:

A 25-year-old male presents with fever and sore throat for 2 weeks, followed by urine protein ++, 15-20 RBCs/HPF, serum creatinine (Cr) 180 μmol/L, and decreased C3. Renal biopsy confirms acute glomerulonephritis. The most likely time for serum C3 to return to normal is:

A 22-year-old male presents with bilateral lower extremity edema and fatigue 10 days after a cold. BP 155/105 mmHg, urinary protein (++), red blood cells (++++), granular casts 1-4/HPF, serum creatinine 106 μmol/L, hemoglobin 122 g/L. These clinical findings are consistent with:

A 25-year-old male presents with fever and chest pain for 2 weeks. Urinalysis shows proteinuria (++), 15-20 RBCs/HPF, Scr 180 μmol/L, and decreased C₃. Renal biopsy is consistent with acute glomerulonephritis. The probable time for serum C₃ to recover is:

A 20-year-old male presents with fatigue and poor appetite for 1 month, oliguria, edema, and hypertension (HTN) for 1 week. Lab findings include anemia, hematuria, proteinuria, normal complement C3, elevated serum creatinine (Cr) and blood urea nitrogen (BUN), and bilateral enlarged kidneys on ultrasound. Clinical diagnosis is 'acute kidney injury (AKI).' If serum anti-glomerular basement membrane (GBM) antibody is positive, which of the following is the most likely diagnosis?

A 50-year-old male presents with edema and oliguria for 1 week. BP 160/100 mmHg, urinary protein 3g/24h, urinary RBCs 20-30/HPF, creatinine (Cr) 633 μmol/L, circulating immune complexes (CIC) (+). Renal pathology: Light microscopy shows 17 glomeruli with partial capillary narrowing, 6 cellular crescents, and 8 fibrocellular crescents. IgG and C3 show granular deposits along capillary walls and mesangial areas. The most likely diagnosis is:

A 33-year-old male with a history of proteinuria 15 years ago, which was never investigated or treated. He developed nausea and vomiting 3 weeks ago. Examination reveals BP 190/120 mmHg, mild lower limb edema, serum creatinine 360 μmol/L, and bilateral small kidneys on ultrasound. Which of the following tests should NOT be performed?

A 60-year-old woman with intermittent edema for 2 years, worsening over half a month, accompanied by dyspnea and hemoptysis for 3 days. BP 150/90 mmHg, positive ascites sign, urinary protein (++++), RBC 0-2/HPF, serum albumin 20 g/L, triglycerides 2.1 mmol/L, enlarged kidneys, and thrombosis in the main renal veins. The most likely diagnosis is:

A 56-year-old male patient presents with 'edema for 2 months'. The renal biopsy pathology report shows: 35 glomeruli with diffuse thickening of the glomerular basement membrane, segmental spike formation, subepithelial fuchsinophilic deposits, focal atrophy of tubular epithelial cells, and interstitial infiltration by lymphocytes and monocytes. The pathological diagnosis is:

An 18-year-old male presents with nephrotic syndrome. 24-hour urinary protein is 4.5g, urine disc electrophoresis shows mid-molecular proteinuria (selective proteinuria), marked edema, normal blood pressure (BP) and renal function. He had similar episodes in childhood which achieved complete remission (CR) with standard steroid therapy, and remained urine test negative until this relapse. Current treatment should be:

A 69-year-old male presents with bilateral lower extremity edema for 4 months. Lab results from 4 months ago show: Hb 150g/L, urinalysis (UA) protein-positive, 24-hour urinary protein quantification 5.9g, plasma albumin (Alb) 19.2g/L, serum creatinine 108μmol/L. The diagnosis is:

A 36-year-old male presents with edema, oliguria for 1 week, BP 120/80 mmHg, urinary protein (++++), plasma albumin 25g/L, and 24h proteinuria of 9g. The most likely diagnosis is:

A 25-year-old male presents with bilateral lower extremity edema for 4 weeks. Examination reveals BP 100/65 mmHg, urinary protein (++++), RBC 1-3/HPF, WBC 0-4/HPF, hemoglobin 120g/L, and serum creatinine 80 μmol/L. Which test should be prioritized for diagnosis?

A 36-year-old male presents with edema and oliguria for 1 week. BP 120/80 mmHg, urinalysis (UA): protein ++++, plasma albumin (Alb) 25 g/L, 24-hour urinary protein quantification 9 g. The most likely diagnosis is:

A 16-year-old male was admitted with sudden onset of severe edema. Blood pressure was normal, ascites sign (+), urinary protein (++++), red blood cells 0-2/HPF, 24-hour urinary protein quantification 6g, serum creatinine (Cr) 100μmol/L, blood C3 and CH50 normal, serum albumin 24g/L. After admission, prednisone 40mg daily was given orally. Renal biopsy at 2 weeks showed mild mesangial proliferation, vacuolar degeneration of tubular epithelial cells, negative immunofluorescence, and foot process effacement on electron microscopy. Proteinuria significantly decreased after 6 weeks of treatment, with complete remission (CR) achieved by 8 weeks. The most likely clinical diagnosis is:

A 32-year-old female presents with proteinuria and hematuria discovered 3 years ago. Three years ago, a routine urinalysis (UA) showed urinary protein (+) and microscopic RBCs 10-20/HPF, with blood pressure (BP) 125-135/80-90 mmHg and normal renal function. Over the past 3 years, repeated 24-hour urinary protein quantification showed 0.6-1.4g. One month ago, she developed a sore throat and fever after catching a cold, followed by gross hematuria the next day. Oral antibiotics improved the sore throat, but urinalysis still showed protein (++) and RBCs 12/HPF. Repeat renal function tests showed BUN 10.4 mmol/L and Cr 345 μmol/L. The most valuable diagnostic method is:

A 24-year-old newly married woman presents with sudden onset of frequency, urgency, dysuria. Urinalysis shows trace proteinuria and numerous WBCs in urine sediment. The most likely diagnosis is:

A 28-year-old woman at 28 weeks of pregnancy presents with low back pain and urinary frequency for 1 week, accompanied by low-grade fever (37°C) for 2 days, and occasional urethral pain after urination. Urinalysis shows pH 6.0, SG 1.015, Pro 0.3g/L, WBC 22/μl, RBC 8/μl, and occasional WBC casts/LP. Urine culture reveals Klebsiella species. The most likely diagnosis is:

A 35-year-old woman presents with urinary frequency, urgency, and dysuria for 5 days, fever (39.5°C), left low back pain with percussion tenderness. Urinalysis shows protein (++), WBC count too numerous to count, and RBC 5-10/HPF. What is the first-line management?

A 35-year-old woman presents with frequency, urgency, and dysuria for 5 days, fever (39.5°C), left costovertebral angle tenderness. Urinalysis shows protein (++), WBCs covering the field, and 5-10 RBCs/HPF. What is the first-line management?

A 35-year-old woman is admitted with fever, chills, and low back pain for 5 days. Right renal area shows percussion tenderness. Urinalysis (UA): red blood cells (RBC) 5-6/HPF, white blood cell (WBC) count 20-30/HPF. Midstream urine culture shows Escherichia coli >10^5/ml. After 3 days of antibiotic therapy, her temperature normalizes. What should be done next?

A 30-year-old female presents with low back pain, urinary frequency, polyuria, blood pressure 160/100 mmHg, urinary protein (+), RBCs 8-10/HPF, WBC count 15-20/HPF. Intravenous pyelogram (IVP) shows right kidney atrophy and pelvic dilation. The most likely diagnosis is:

A 64-year-old woman with BP 162/90mmHg on routine checkup 6 months ago (normal urinalysis and renal function) was started on captopril. Now presents with polyuria, fatigue, BP 190/110mmHg, UA: protein+, renal function: BUN 16mmol/L, Cr 324μmol/L, serum K+ 3.0mmol/L. Renal ultrasound: left kidney 11.8cm×5.2cm, right kidney 9.0cm×3.8cm. The most likely diagnosis is:

A 25-year-old female is admitted with facial rash and bilateral lower extremity edema for 2 years, and decreased urine output for 2 weeks. Physical examination: BP 150/90 mmHg, maculopapular rash in a butterfly distribution on the face, pitting edema in both lower extremities. Laboratory tests: urine sediment microscopy shows red blood cells (RBCs) covering the entire field, urinary protein 6.5 g/d, serum albumin 27.8 g/L, serum creatinine 254 μmol/L. Blood C3 decreased, antinuclear antibody (ANA) positive, ds-DNA positive. Ultrasound: both kidneys slightly enlarged. The most likely diagnosis is:

A 23-year-old female was admitted with recurrent arthralgia for over a year and edema for 1 month. Physical examination: blood pressure (BP) 150/90 mmHg, marked facial and lower extremity edema, knee joint swelling and mild tenderness. Hemoglobin (Hb) 78g/L, white blood cell (WBC) count 3.0×10⁹/L, platelets (PLT) 50×10⁹/L. Urinalysis: proteinuria (++++), red blood cells (RBC) 10–20/HPF, WBC 5–10/HPF, 24-hour urinary protein quantification 5.6g (non-selective proteinuria), alanine aminotransferase (ALT) 50U, albumin to globulin ratio (A/G) 30/40g/L, serum immunoglobulin G (IgG) 22g/L. The most helpful diagnostic test would be:

A 75-year-old male with a 30-year history of type 2 diabetes mellitus (T2DM) developed proteinuria and hypertension (HTN) over the past 6 years, with progressive renal dysfunction over the last 2 years. For the past 3 months, he has experienced nausea and vomiting, along with bilateral lower extremity edema. Recent laboratory tests show serum K+ 5.5 mmol/L, CO2CP 16.5 mmol/L, Cr 830 μmol/L, Hb 6.5 g/dL, and blood glucose 16 mmol/L. He has a history of subtotal gastrectomy. The patient's current renal function is at which stage?

A 64-year-old woman had a blood pressure (BP) of 162/90 mmHg during a physical exam 6 months ago, with normal urinalysis (UA) and renal function. She was then treated with captopril. One month ago, she developed nocturia, fatigue, and BP of 190/110 mmHg. UA showed protein (+), renal function tests revealed blood urea nitrogen (BUN) 16 mmol/L, creatinine (Cr) 324 μmol/L, and serum potassium (K) 3.0 mmol/L. Renal ultrasound showed left kidney 11.8 cm × 5.2 cm and right kidney 9.0 cm × 3.8 cm. Based on these findings, the most likely diagnosis is:

A 33-year-old female presents with bilateral lower extremity edema for 1 month. She has a history of chronic hepatitis B for 3 years. Urinalysis shows proteinuria and red blood cells 20 per HPF. 24-hour urinary protein quantification is 4.0 g, plasma albumin 28.5 g/L, serum creatinine 90 μmol/L, and both HBsAg and HBeAg are positive. The most likely diagnosis is:

A 48-year-old male with a history of hepatitis B presented with nephrotic syndrome 2 weeks ago. Physical exam: BP 165/98 mmHg, no hepatosplenomegaly, ascites (+). Laboratory tests: urine protein (++++), RBC 10-15/HPF, WBC 0-2/HPF, 24-hour urinary protein 4.0g, non-selective proteinuria, normal complement and renal function. No evidence of malignancy. The most likely diagnosis is:

A 33-year-old female presents with bilateral lower extremity edema for 1 month. She has a 3-year history of chronic hepatitis B. Urinalysis shows proteinuria and red blood cells 20 per HPF. 24-hour urinary protein quantification is 4.0 g, plasma albumin 28.5 g/L, serum creatinine 90 μmol/L, and both HBsAg and HBeAg are positive. The most likely diagnosis is:

A 70-year-old male with no prior medical history received gentamicin for infection treatment 10 days ago. Current findings: urine output 800ml, urinalysis (UA) shows Pro(+), granular casts present, blood urea nitrogen (BUN) 18.8mmol/L, creatinine (Cr) 373μmol/L, HGB 12.1g/L. The most likely cause of acute renal failure is:

A 56-year-old male patient developed hemorrhagic shock 4 days ago due to a car accident. Over the past 3 days, his daily urine output has been 150-250ml (oliguria), with generalized edema, shortness of breath preventing lying flat, respiratory rate 26 brpm, BP 160/95 mmHg, bilateral lung rales/crackles, heart rate 126 bpm, serum sodium (Na) 130 mmol/L, and serum creatinine (Cr) 658 μmol/L. The LEAST likely cause of oliguria in this case is:

A 25-year-old male is admitted emergently 10 hours after crush injury, with anuria, extensive soft tissue swelling, and azotemia, diagnosed with acute tubular necrosis. The clinical sign determining the need for emergency hemodialysis is:

A 20-year-old male presents with oliguria and edema 2 weeks after an upper respiratory tract infection (URI). Physical exam: BP 173/105 mmHg, marked eyelid and subcutaneous edema, fine crackles heard at the lung bases. Laboratory tests: urine protein (++), RBC 20-25/HPF, Hb 110g/L, serum Cr 720 μmol/L, serum K 7.0 mmol/L, CO2CP 18 mmol/L, low C3, mild arteriovenous crossing sign on fundoscopy. The most likely diagnosis is:

A 35-year-old male patient presents with headache and dizziness for 6 months, worsening over the past week accompanied by blurred vision, nausea, vomiting, and poor appetite. BP: 190/105 mmHg, Hb: 69 g/L, urinary protein (++), urine sediment examination shows 3-5 RBCs/HPF, serum creatinine: 806 μmol/L, BUN: 33 mmol/L, Ccr: 9 ml/min, CO₂CP: 14 mmol/L. Ultrasound reveals bilateral kidney sizes: left kidney 9.1×4.8×14.0 cm, right kidney 8.9×4.5×3.8 cm. The most likely diagnosis is:

A 48-year-old female patient with chronic glomerulonephritis (CGN) has been on hemodialysis for 2 years. She recently experiences difficulty walking and lower limb bone pain, suspected of renal osteodystrophy. Which is the preferred diagnostic method for early confirmation?

A 35-year-old male presents with hypertension, visual disturbances, nausea and vomiting. Examination: BP 210/120 mmHg, heart border enlarged to the lower left, Hb 65g/L, urinary protein (+++), RBC 5-10/HPF, Cr 760 μmol/L, ultrasound shows bilateral kidney shrinkage, retinal hemorrhages and exudates. No prior history of kidney disease. The most likely diagnosis is:

A 45-year-old male with a history of chronic nephritis for 10 years and hypertension (HTN) for 5 years has shown gradual elevation of serum creatinine over the past 2 years. Current GFR is 50ml/(min·1.73m²). What is the stage of his chronic kidney disease (CKD)?

An 18-year-old female, who had fever due to acute suppurative tonsillitis 3 weeks ago and improved after treatment, recently developed periorbital edema, elevated blood pressure, oliguria, dyspnea, and inability to lie flat. The most likely diagnosis is:

A 28-year-old male presents with gross hematuria and facial edema 2 weeks after an upper respiratory tract infection (URI). Physical examination reveals blood pressure (BP) of 150/100 mmHg, urinary protein (+), red blood cells (RBCs) throughout the field of view, and serum creatinine (Cr) of 180 μmol/L. The most likely diagnosis in this case is: