1. A 43-year-old male with end-stage chronic kidney disease has just undergone a renal transplant. Two days post-operatively while still in the renal ward, he was found to have rapid, shallow respiration and anuria. Physical examination revealed generalised oedema. His vitals are as follows: RR: 23 breaths per minute, BP: 180/90 mmHg, HR: 117 beats per minute. Blood tests were done and they showed the following: Sodium 137 mmol/L, Potassium 6.5 mmol/L, and Creatinine 667 μmol/L. What is the best management approach for this patient?

• Calcium gluconate
• Insulin and Glucose
• Hemodialysis
• Intravenous fluids

2. A 53-year-old man diagnosed with type 2 diabetes has tested positive for microalbuminuria on two separate occasions 3 months apart. He is a non-smoker and there is no family history of heart disease. Physical exam reveals the heart is regular, BMI is 31 kg/m2 and BP is 140/90 mmHg. His eGFR is 57 mL/min. Past medical history is significant for CKD. What therapy should be offered to this patient?

• Angiotensin-converting enzyme inhibitor
• Calcium channel blocker
• Beta-blocker
• Diuretic

3. A 18-year-old male with ℅ facial puffiness and oedema in his lower extremities. His BP was 137/96 mmHg. Urinalysis showed Proteinuria (2+ by a dipstick test) and microscopic hematuria. His renal function had deteriorated, with increased BUN (30.3 mg/dL) and creatinine (3.42 mg/dL) levels. Renal biopsy findings are as follows. Which of the following statement is FALSE regarding this condition?

• Systemic illnesses like Henoch-Schönlein purpura (HSP) are closely linked to this disease
• Creatinine >120 mmol/L at presentation and hypertension are predictors of poor renal outcomes
• Diagnosis should be confirmed by renal biopsy
• Cyclophosphamide is commonly used for the treatment of this condition

4. A 21-year-old female with complaints of decreased frequency of urination and hemoptysis for 3 days. The patient gave h/o 2 weeks of cough prior to admission and experienced an episode of brown-coloured urine 1 week later. Blood results show anaemia, elevated urea, and creatinine: 1108.0 µmol/l. Urine analysis indicated protein-positive (+) and the presence of WBCs. CXR identified diffuse density parenchymal lesions with fibrosis in the lungs. Which of the following is the most likely additional finding?

• Anti-PLA2R autoantibodies
• Anti-GBM antibodies
• Anti-nucleosome autoantibodies
• Anti-neutrophil cytoplasmic antibodies

5. A 15-year-old without any major past medical illness presented with c/o intermittent headache, visual blurring, vomiting for the last 2 months, and periorbital puffiness for 20 days. His headache was associated with episodes of vomiting and transient bilateral visual blurring without any redness of the eyes or ocular pain. No h/o focal deficit, seizure, or LOC. There was no complaint of fever, preceding sore throat, pedal oedema, decrease in urine output, dysuria, hematuria, anorexia, or any other significant complaint. O/E: Creatinine of 2.1 mg/dL and urine analysis showed Protein 2+, RBC 2-5/hpf, Pus cells 1-2/hpf, and Casts granular 6-8/lpf. His fundus examination revealed an “oil drop” appearance. What is the most likely diagnosis?

• Wegners Granulomatosis
• Chrug Strauss Syndrome
• Alport Syndrome
• Goodpasture’s disease

6. Renal biopsy results of a 65-year-old male along with histopathology findings are as follows. Which of the following is the most likely diagnosis?

• Primary Membranous nephropathy
• Secondary Membranous nephropathy
• Lupus nephritis
• Renal Cell Carcinoma