A#23

Its light chain nephropathy.

A#24

I thought it is post infectious glomerulonephritis....But It is IgA naphropathy.

Q#25
A 54-year-old woman is evaluated for a creatinine level of 114.95 μmol/L. 18 months ago, this value was 79.58 μmol/L. She has a 5-year history of type 2 diabetes mellitus; hyperlipidemia; and hypertension well controlled with lisinopril, hydrochlorothiazide, and atenolol. She also uses glipizide and simvastatin. Laboratory studies reveal a normal hemoglobin level.

Which of the following diagnostic studies is most appropriate for this patient?
1)24-Hour urine collection for proteinuria
2)Kidney ultrasonography
3)Measurement of urine microalbumin
4)Measurement of hemoglobin A1c

Q#26
A 28-year-old woman is evaluated for a serum calcium level of 2.74 mmol/L obtained during a routine physical examination.
All other laboratory values are normal.
PTH level was subsequently checked and is 40 ng/L.
The patient is healthy and has no symptoms of polyuria, constipation, or fatigue.
Her mother and maternal grandfather have a history of hyperparathyroidism, and they both underwent parathyroidectomy but remained mildly hypercalcemic.
The patient had a recent renal ultrasound that showed no evidence of nephrolithiasis. Her diet is rich in dairy products, and she has no history of gastrointestinal illness.

Which of the following tests would be most likely to confirm the diagnosis?

1)25-hydroxyvitamin D
2)1,25-Dihydroxyvitamin D
3)Urine calcium/creatinine clearance ratio
4)Parathyroid hormone–related peptide

Q#27

A 46-year-old woman is evaluated for a serum calcium concentration of 2.84 mmol/L discovered on routine screening.
A dual-energy x-ray absorptiometry showed T scores at the lumbar spine and left femoral neck of −0.88 and −0.05 respectively. There is no history or evidence of renal stones, bone fracture, cognitive impairment, or fatigue.
The intact serum parathyroid hormone level is 115 ng/L. The serum creatinine is 0.9 mg/dL (79.58 µmol/L). The urine calcium/creatinine clearance ratio is greater than 0.01, but the 24-hour urine calcium excretion is 6.3 mmol.

Which of the following is the most appropriate next step in the management of this patient? and Why????
1)Observation
2)Intravenous pamidronate
3)Mammography
4)Parathyroidectomy
5)Low-calcium diet

Q#28

A 48-year-old man is evaluated for weakness and fatigue. He has a history of hypertension and gout.
Medications include ramipril, hydrochlorothiazide, and colchicine.
Social history is significant for having lost his job 2 years ago, after which he has been drinking beer and wine every day. He does not have episodes of delirium tremens but admits to feeling guilty about his alcohol intake.

Physical examination reveals a disheveled man in no acute distress. The blood pressure is 135/80 mm Hg, and pulse rate is 78/min. Chvostek's sign is positive on the right. The liver is palpated 3 cm below the right costal margin and is tender to palpation. No spider angiomata or palmar erythema is noted.

Lab:Hematocrit 33%, Sodium 133 mmol/L, Potassium 3.4 mmol/L, BUN 8.93 mmol/L,
Creatinine 106.1 µmol/L,
Alanine aminotransferase 50 U/L, Aspartate aminotransferase 110 U/L
Alkaline phosphatase 55 U/L
Albumin 35 g/L, Calcium 1.8 mmol/L.

Which of the following is the most appropriate next test in the evaluation of this patient?
1)Parathyroid hormone
2)25-hydroxyvitamin D
3)1,25 hydroxyvitamin D3
4)Phosphate
5)Magnesium