Renal Urogenital

A 70-year-old man is brought to the emergency department with fever, rigors and confusion three days after starting treatment for a presumed lower respiratory tract infection. He has a background of type 2 diabetes and benign prostatic hyperplasia, and takes ramipril and ibuprofen for chronic back pain. On examination he is febrile at 38.9°C, heart rate 118 beats/min, blood pressure 88/50 mmHg, respiratory rate 26/min and oxygen saturation 93% on room air, with coarse crackles at the right lung base. He is commenced on broad-spectrum antibiotics and intravenous fluids for septic shock. Serum creatinine has risen from a baseline of 100 μmol/L to 250 μmol/L over the past 48 hours, and urine output over the last six hours has averaged 0.3 mL/kg/h despite 2 L of balanced crystalloid. Bladder scan shows no urinary retention and renal tract ultrasound is unremarkable. Which of the following best describes the underlying process and the most appropriate immediate management?

A 68-year-old man with end-stage kidney disease attends for his routine Monday, Wednesday, Friday haemodialysis session. Two hours into a 4-hour run, with 2.5 L of ultrafiltration already achieved, he develops sudden light-headedness, nausea and central chest tightness. His blood pressure has fallen from a pre-dialysis 150/90 mmHg to 82/50 mmHg, heart rate is 110 beats/min, and he appears pale and diaphoretic. He has a background of ischaemic heart disease with a prior anterior STEMI and moderate left ventricular impairment. The dialysis nurse alerts you as the covering emergency physician. What is the most appropriate immediate management?

A 34-year-old man with a known family history of autosomal dominant polycystic kidney disease (ADPKD, confirmed PKD1 mutation in his father) attends the emergency department with a two-week history of dull right flank discomfort. He denies fever, dysuria or haematuria. He has no other past medical history and takes no regular medications. On examination his blood pressure is 152/94 mmHg, heart rate 82 bpm, and he is afebrile. Abdominal examination reveals bilateral irregular flank masses that are ballotable and non-tender. Bloods show a creatinine of 95 µmol/L (eGFR 78 mL/min/1.73m²) and normal liver function tests. A renal ultrasound performed in the department confirms multiple bilateral cysts with markedly increased total kidney volume, and review of a scan from two years ago shows significant interval growth in cyst burden, consistent with rapidly progressive disease (Mayo imaging classification 1D). What is the most appropriate management approach for this patient?

A 30-year-old woman presents to the emergency department with mild suprapubic discomfort. She has no red-flag features and is haemodynamically stable (BP 118/72 mmHg, HR 76 bpm, afebrile), with a soft, non-tender abdomen and normal pelvic examination. During the consultation she mentions that she and her partner have been having regular unprotected intercourse for the past 14 months without conceiving. Her cycles are regular (28-30 days), she has no history of pelvic inflammatory disease, endometriosis or abdominal surgery, and her partner has no known urological issues. She asks the emergency physician what she should do next regarding her fertility. What is the most appropriate next step in her management?

A 28-year-old man presents to the emergency department after noticing a painless swelling in his left testis over the past few weeks. On reviewing his history, which of the following features would confer the greatest increased risk of testicular malignancy?

A 30-year-old man with lupus nephritis and stage 4 chronic kidney disease presents to the emergency department with increasing peripheral oedema, dyspnoea and a 3 kg weight gain over one week. Observations are BP 158/94 mmHg, HR 92 bpm, RR 18, SpO2 97% on room air, afebrile. Examination reveals bilateral pitting oedema to the knees and mild ascites. Bloods show creatinine 380 µmol/L (baseline 220), eGFR 15 mL/min/1.73m², urine protein:creatinine ratio markedly elevated, and active urinary sediment. Rheumatology and nephrology confirm a lupus nephritis flare requiring urgent induction therapy with cyclophosphamide. While counselling him about admission and treatment, he mentions that he and his partner have been trying unsuccessfully to conceive for the past year, and he reports reduced libido and occasional erectile difficulty. He has no genital pain or trauma, and testicular examination is unremarkable apart from mildly reduced testicular volume bilaterally. What is the most appropriate next step regarding his fertility?