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Renal and Endocrine Disorders Flashcards

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  1. A 45-year-old man with a family history of renal failure has flank pain, hypertension, haematuria and bilateral enlarged kidneys with multiple cysts. What is the most likely diagnosis?

    Answer: Autosomal dominant polycystic kidney disease

    Bilaterally enlarged cystic kidneys with a positive family history indicate autosomal dominant polycystic kidney disease.

  2. A 19-year-old woman is found to have a TSH of 8 mU/L with a normal free T4 and is asymptomatic. What is the appropriate management of this subclinical hypothyroidism?

    Answer: Repeat thyroid function in 2-3 months

    Mildly raised TSH with normal T4 and no symptoms should be rechecked before deciding on treatment.

  3. A 68-year-old man on metformin undergoes a contrast CT and develops oliguric acute kidney injury 48 hours later. What is the most likely cause?

    Answer: Contrast-induced nephropathy

    Iodinated contrast can cause an acute tubular injury within 48-72 hours, especially in those with pre-existing renal impairment.

  4. A 30-year-old man with type 1 diabetes reports early morning sweating and headaches, with a fasting hyperglycaemia. Overnight readings show hypoglycaemia at 3am. What does this pattern describe?

    Answer: Somogyi phenomenon

    Nocturnal hypoglycaemia triggering counter-regulatory rebound morning hyperglycaemia describes the Somogyi effect.

  5. A 52-year-old woman is found to have an asymptomatic serum calcium of 2.85 mmol/L with an inappropriately normal PTH. What is the most likely diagnosis?

    Answer: Primary hyperparathyroidism

    A non-suppressed PTH in the face of hypercalcaemia indicates primary hyperparathyroidism.

  6. A young woman presents with hypertension, hypokalaemia and metabolic alkalosis but with LOW aldosterone and low renin. Genetic testing confirms a sodium channel mutation. What is the diagnosis?

    Answer: Liddle syndrome

    Liddle syndrome is an inherited gain-of-function of the epithelial sodium channel causing hypertension with suppressed renin and aldosterone.

  7. A 60-year-old man with heart failure is started on an ACE inhibitor and his creatinine rises by 40% within a week. What is the most likely explanation?

    Answer: Bilateral renal artery stenosis

    ACE inhibitors reduce efferent arteriolar tone and precipitate a marked creatinine rise when renal perfusion depends on it, as in bilateral renal artery stenosis.