Renal & Urology — MCQs

A 72-year-old man presents with confusion and lethargy. He has a history of small cell lung cancer currently receiving chemotherapy. Blood tests reveal: sodium 115 mmol/L, potassium 4.2 mmol/L, urea 3.5 mmol/L, creatinine 78 μmol/L, glucose 5.2 mmol/L, serum osmolality 240 mOsm/kg, urine sodium 45 mmol/L, urine osmolality 420 mOsm/kg. Clinically, he appears euvolaemic with no oedema. Thyroid and adrenal function are normal. What is the most appropriate initial management?

A 55-year-old woman with chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m²) attends her nephrology clinic appointment. Her recent blood tests show: haemoglobin 95 g/L, ferritin 180 μg/L, transferrin saturation 25%, calcium 2.05 mmol/L, phosphate 1.95 mmol/L, PTH 15.2 pmol/L (normal range 1.6-6.9), vitamin D 35 nmol/L. She has no symptoms. Which complication of chronic kidney disease requires the most urgent treatment intervention?

A 68-year-old man with type 2 diabetes presents to the emergency department with a 3-day history of vomiting and diarrhoea. His regular medications include metformin, ramipril, and furosemide. On examination, he appears dehydrated with reduced skin turgor. Blood pressure is 95/60 mmHg, pulse 105 bpm. Blood tests show: creatinine 385 μmol/L (baseline 95 μmol/L), urea 28.5 mmol/L, potassium 5.8 mmol/L. Urinalysis shows no protein or blood. What is the most appropriate initial management step?