A 64-Year-Old Man Who Recently Moved to the Area Comes

question 87

Multiple Choice

A 64-year-old man who recently moved to the area comes to the office for a new patient evaluation.  He has chronic low back pain, resulting from an injury 8 years ago, for which he uses several over-the-counter analgesics.  Most recently, the patient has been taking naproxen daily.  He has no other joint pain, fever, rash, urinary symptoms, or other medical conditions.  Blood pressure is 135/70 mm Hg and pulse is 78/min.  Examination shows trace lower extremity edema.  Neurologic and musculoskeletal examinations reveal no abnormalities.  Laboratory results show blood counts within normal limits, blood urea nitrogen of 12 mg/dL, and serum creatinine of 2.0 mg/dL.  Urinalysis reveals 1+ protein and 3-4 white blood cells/hpf.  Renal ultrasound demonstrates bilateral shrunken and irregular kidneys with a few papillary calcifications.  Which of the following is the most likely cause of this patient's renal dysfunction?

• A)Chronic interstitial nephritis
• B)Chronic pyelonephritis
• C)Crystal nephropathy
• D)Focal segmental glomerular sclerosis
• E)Ischemic tubular necrosis
• F)Renal artery stenosis

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Definitions:

Migratory Bird Species

Birds that cyclically move between breeding and non-breeding areas, often covering long distances across regions or continents.

Environmental Quality

The condition or health of the natural environment, measured by factors such as air and water purity, biodiversity, and the presence of pollutants.

Constitutional Democracy

A system of government where the power is vested in the people and exercised according to a constitution, which outlines the rights and responsibilities of citizens and the governing entities.

Environmental Laws

A body of laws and regulations designed to protect the environment by governing human activities that may harm ecological balance, including air and water pollution, waste management, and conservation efforts.